Feedback (Giver) Assessment Form

Student Name:
Feedback Giver Questions Rubric

When giving feedback, to what extent did this A Good A Great

N/A None A little Somewhat
team member… Amount Deal
1. …deliver feedback in a kind, but
still professional tone? (positive)
2. …offer specific and constructive
feedback? (positive)
3. …provide actionable advice for moving
ahead? (positive)
4. …provide adequate justification/evidence
for their suggestions? (positive)
5. …stay focused on important aspects (i.e.,
they did not lose sight when challenged or the
situation felt awkward)? (positive)
6. …Discuss possible implications if a
team member doesn’t change? (positive)
7. …make questionable assumptions? (negative)
8. …Attempt to “ease in” or try to reach
premature agreement before delivering
important feedback? (negative)

Overall Perceptions
9. Overall, is the feedback given likely to
YES NO
result
in a meaningful change?
10. Overall, how would you evaluate Not bad, but
the usefulness of this feedback? definitely Decent/ Really
Poor Outstanding
room for Average Strong
improvement.

Use the following pages to make note of key examples and to offer your suggestions for how this team member
might get even better at giving feedback in the future:
Feedback notes, cont’d…