Juggling Multiple Responsibilities - 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Surveys measuring the ability to handle 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)
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


Juggling Multiple Responsibilities

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Observes, analyzes, and responds to merchandise needs while serving customers and accomplishing operational tasks.
  1. Organizes tasks for the most efficient order of completion.
  1. Manages impact of increased traffic flow and freight receipt by detailed planning of controllables and by anticipating and reacting positively to uncontrollables.
  1. Ranks the importance of tasks to make sure critical tasks are completed first.
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. Is proactive in developing solutions to problems.
  1. Conducts critical-incident review immediately after the event.
  1. Initiates actions to get things done.
  1. Seeks new opportunities for advancement.
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. Reduces staff turnover.
  1. Establishes stretch goals to advance skills and output.
  1. Follows-up and takes action when goals are not met to ensure better results in the future.
  1. Sets challenging goals.
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. Takes a lot of pride in their work.
  1. Is planful and organized.
  1. Keeps themselves and others focused on constant improvement.
  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. Learns from previous bad decisions and rarely repeats them.
  1. Has a good rapport other people which is helpful in making decisions on the team.
  1. Examines relevant factors needed to make a decision.
  1. Comes across as confident, decisive, and resilient
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. ...Overall Performance
  1. Has great overall performance
  1. ...Produce Quality
  1. Shown significant improvement in 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. Identifies the root cause of a problem.
  1. Identifies problems and issues needing resolution.
  1. Analyzes issues and reduces them to their component parts.
  1. Prioritizes various actions to be taken when solving a problem.
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. Coordinates the execution of compliance strategies across departments.
  1. Establishes a governance body to monitor and guide the organization's activities.
  1. Submits complete applications for necessary certifications.
  1. Responds promptly to inquiries from regulatory bodies.
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. Consistently keeps commitments.
  1. Demonstrates congruence between statements and actions.
  1. Builds and maintains the trust of others.
  1. Is trustworthy; is someone I can trust.
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. Develops the skills and capabilities of others.
  1. Coaches employees in how to strengthen knowledge and skills to improve work performance.
  1. Helps employees to maintain high personal standards.
  1. Addresses employee behavior problems effectively.
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. Encourages dynamic growth opportunities.
  1. Has a strategic awareness on how to promote the organization.
  1. Can work effectively in an environment of uncertainty.
  1. Able to adapt the department to changing business demands and climate.
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. Keeps excellent records for financial transparency.
  1. Ensures others follow the correct rules and regulations on fiscal matters.
  1. Effective in using Company's resources.
  1. Monitors expenses and verifies the need for items purchased.
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.