Feedback Delivery
Worksheet

COMMUNICATION & RELATIONSHIPS TOOLS

A preparation tool for delivering specific, behavior-based feedback
that the other person can actually use.

Preparing to Be Heard

Feedback that does not land is usually not a delivery problem - it is a preparation problem. Leaders give vague feedback because they have not sharpened the observation: "You need to be more strategic" is not feedback. It is a category without content. The person receiving it does not know what to change, and the person giving it has not actually said what they saw.

The SBI model - Situation, Behavior, Impact - provides a structure for getting specific. It forces you to name when and where something happened, what specifically was said or done, and what effect that behavior had. That level of specificity is what allows the other person to do something with the feedback. Without it, feedback becomes a judgment about character rather than a description of behavior, and judgments produce defensiveness rather than change.

Most leaders know the SBI model. The challenge is applying it under pressure - in the moment, or when the feedback is emotionally charged. This worksheet removes the pressure by doing the thinking in advance. The practice run section at the end matters more than leaders expect.

How to Use This Worksheet

  1. Start with the behavior, not the interpretation. What did you see or hear? Not what you think it means, not the pattern it fits - the specific observable action.
  2. Name one situation, not a pattern. "Every time you present to the board, you..." mixes incidents and becomes harder to defend and harder to receive. Pick the most recent or most significant occurrence.
  3. Be honest about impact. Not what could theoretically happen, but what actually did. On you, on the team, on the work.
  4. State what you want to see, not what you don't want. "I'd like you to..." is more actionable than "stop doing X."
  5. Write out and read aloud the full feedback statement before delivering it. If you stumble on a sentence, that is a signal that part needs more clarity.
1

Feedback Worksheet

S
Situation
B
Behavior
I
Impact
Situation

Describe the specific situation where you observed the behavior. When and where did it happen?

Behavior

What specifically was said or done? (Observable only - not interpreted.)

Impact

How did this affect you, the team, or the work? Be specific.

2

Feedback Worksheet (continued)

What I'd Like to See

What change or continuation are you requesting?

How I'll Follow Up

How will you check in or support them going forward?

Practice Run

Write out the complete feedback statement as you plan to deliver it:

Before the conversation:

Is there anything about this situation that you have not fully acknowledged - something the other person might say in response that would be fair? How will you receive that?

3

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