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Juggling Multiple Responsibilities - 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Surveys Measuring Juggling Multiple Responsibilities:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Instructions:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses, and will be not making any changes, click the Complete button.

Competencies Included:
Juggling Multiple Responsibilities, Action, Achievement, Excellence, Decision Making, Performance, Analytical, Regulatory/Compliance, Trustworthy, Coaching, Entrepreneurship, Fiscal Management
Sample Result Document:
Sample Results
Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team
Edit this Survey
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Juggling Multiple Responsibilities

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is aware of the deadlines for specific tasks/assignments.
  1. Completes multiple tasks simultaneously.
  1. Builds in extra time in the schedule for unplanned events/occurrences.
  1. Assesses current capabilities before committing to new requests from customers.
If [Participant Name] were to make improvements in Juggling Multiple Responsibilities, what are your suggestions for how he/she can improve this?

Action

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Effectively handles multiple complex issues simultaneously.
  1. Takes action when necessary.
  1. Addresses safety issues immediately.
  1. Is proactive rather than reactive in work.
If [Participant Name] were to make improvements in Action, what are your suggestions for how he/she can improve this?

Achievement

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Allocates resources as needed to accomplish organizational goals.
  1. Uses established goals and performance measures to keep track of performance.
  1. Champions process improvements that enhance productivity, compliance, and overall success.
  1. Defines precise, structured objectives that helps the department progress and holds employees accountable.
If [Participant Name] were to make improvements in Achievement, what are your suggestions for how he/she can improve this?

Excellence

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Keeps themselves and others focused on constant improvement.
  1. Can be counted on to add value wherever they are involved.
  1. Is planful and organized.
  1. Demonstrates the functional or technical skills necessary to do their job.
If [Participant Name] were to make improvements in Excellence, what are your suggestions for how he/she can improve this?

Decision Making

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Makes good decisions for the department.
  1. Understands how their decisions will affect others.
  1. Is able to make decisions quickly.
  1. Facilitates meetings with others to try to consider alternative courses of action.
If [Participant Name] were to make improvements in Decision Making, what are your suggestions for how he/she can improve this?

Performance

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Works effectively in the department.
  1. Works well in this position.
  1. Able to organize work.
  1. Sets a high standard for job performance.
If [Participant Name] were to make improvements in Performance, what are your suggestions for how he/she can improve this?

Analytical

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Reduces issues to their fundamental elements.
  1. Uses logic and reasoning to identify which pieces of information are useful and which are not.
  1. Ensures that the foundation of an analysis is based on reliable and relevant data.
  1. Determines if facts are consistent across multiple sources.
If [Participant Name] were to make improvements in Analytical, what are your suggestions for how he/she can improve this?

Regulatory/Compliance

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Keeps track of changes in legislation affecting regulatory compliance.
  1. Creates a company compliance manual for distribution to the employees.
  1. Keeps detailed records of compliance measures.
  1. Creates and distributes code of ethics and code of conduct.
If [Participant Name] were to make improvements in Regulatory/Compliance, what are your suggestions for how he/she can improve this?

Trustworthy

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Communicates an understanding of the other person's interests, needs and concerns.
  1. Is trustworthy; is someone I can trust.
  1. Demonstrates a sense of responsibility and commitment to public trust.
  1. Consistently keeps commitments.
If [Participant Name] were to make improvements in Trustworthy, what are your suggestions for how he/she can improve this?

Coaching

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Understands and respects the employee's unique perspective and challenges.
  1. Coaches and mentors employees to achieve excellence.
  1. Asks employees to define or explain their goals, strategies, and motivations.
  1. Frequently looks for opportunities to coach employees.
If [Participant Name] were to make improvements in Coaching, what are your suggestions for how he/she can improve this?

Entrepreneurship

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Exhibits determination and passion in completion of goals.
  1. Has a strategic awareness on how to promote the organization.
  1. Excellent at managing relationships with stakeholders.
  1. Is comfortable operating in an environment of uncertainty.
If [Participant Name] were to make improvements in Entrepreneurship, what are your suggestions for how he/she can improve this?

Fiscal Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
  1. Effective in using Company's resources.
  1. Ensures others follow the correct rules and regulations on fiscal matters.
  1. Keeps excellent records for financial transparency.
If [Participant Name] were to make improvements in Fiscal Management, what are your suggestions for how he/she can improve this?

  1. What are [Participant Name Here]'s greatest strengths demonstrated this year?


  2. What are [Participant Name Here]'s areas for development?


  3. Please give any final comments or suggestions for [Participant Name Here]'s assessment.