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. Manages impact of increased traffic flow and freight receipt by detailed planning of controllables and by anticipating and reacting positively to uncontrollables.
  1. Keeps track of multiple assignments and deadlines.
  1. Spends the most time and effort on critical tasks first.
  1. Organizes tasks for the most efficient order of completion.
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 not afraid to take action when necessary.
  1. Completes tasks on time in spite of delays in the process.
  1. Takes advantage of opportunities to move the organization forward.
  1. Looks for extra ways to help the department achieve performance goals.
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. Completes work to a high technical standard
  1. Improved the quality of work on the production line.
  1. Strives to exceed standards of performance.
  1. Helps others to improve or meet standards of performance.
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. Demonstrates the analytical skills to do their job.
  1. Takes a lot of pride in their work.
  1. Demonstrates the functional or technical skills necessary to do their job.
  1. Can be counted on to add value wherever they are involved.
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. Receptive to new ideas from others when making decisions.
  1. Does not lose sight of the big picture when making decisions
  1. Determines constraints that may impact what decisions are acceptable.
  1. Willing to change their strategy if new information arises.
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. Effectively organizes resources and plans
  1. Sets a high standard for job performance.
  1. Has great overall performance
  1. Works effectively in the department.
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. Selects the appropriate techniques for analysis.
  1. Balances risks and costs with the rewards and probabilities of success when decisions.
  1. Identifies the root cause of a problem.
  1. Implements data validation techniques and methods.
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. Familiar with EEOC, FLSA, OSHA and ERISA acts/standards.
  1. Performs regular compliance audits.
  1. Provides documents and reports as needed to maintain compliance with laws.
  1. Knows who to contact at various regulatory agencies if needed.
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. Demonstrates a sense of responsibility and commitment to public trust.
  1. Takes ownership, delivers on commitments
  1. Builds and maintains the trust of others.
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. Helps employees to maintain high personal standards.
  1. Helps employees to understand responsibilities, authority, and expectations.
  1. Coaches employees in how to strengthen knowledge and skills to improve work performance.
  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. Finds unique ways to go around barriers to success.
  1. Is comfortable operating in an environment of uncertainty.
  1. Excellent at managing relationships with stakeholders.
  1. Maintains a high level of energy to respond to demands of the job.
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. Develops of the department's annual budget.
  1. Monitors spending.
  1. Effective in using Company's resources.
  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.