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. Can multitask while performing all of their other responsibilities and activities.
  1. Uses a scheduler/planner to keep tasks organized and on time.
  1. Plans and organizes continuously while performing all other responsibilities and activities.
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. Will take action to address a problem rather than to wait to confer with others about the situation.
  1. Seeks new opportunities for advancement.
  1. Completes tasks on time in spite of delays in the process.
  1. Rapidly adapts to changes in the situation.
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. Takes immediate action of projects that fall behind schedule.
  1. Takes calculated risks to achieve significant rewards.
  1. Accepts setbacks and challenges as improvement opportunities
  1. Completed training on the new equipment.
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. Is planful and organized.
  1. Demonstrates the analytical skills to do their job.
  1. Can be counted on to add value wherever they are involved.
  1. Produces high quality work.
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. Comes across as confident, decisive, and resilient
  1. Formulates imaginative decisions.
  1. Carefully evaluates information before making an important decision.
  1. Exercises good judgment by making sound and informed decisions.
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. Sets a high standard for job performance.
  1. Works well in this position.
  1. Listens and responds to issues and problems
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. Analyzes issues and reduces them to their component parts.
  1. Implements data validation techniques and methods.
  1. Selects the appropriate techniques for analysis.
  1. Identifies opportunities for progress and innovation.
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. Develops compliance reports in accordance with federal and industry regulations.
  1. Knows who to contact at various regulatory agencies if needed.
  1. Familiar with EEOC, FLSA, OSHA and ERISA acts/standards.
  1. Establishes clear communication channels and lines of communication for compliance related issues.
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. Demonstrates a sense of responsibility and commitment to public trust.
  1. Delivers on promises made.
  1. Works in a way that makes others want to work with her/him.
  1. Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
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 understand responsibilities, authority, and expectations.
  1. Addresses employee behavior problems effectively.
  1. Helps employees to maintain high personal standards.
  1. Provides clear, motivating, and constructive feedback.
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. Devotes a certain amount of time and effort to developing new business opportunities.
  1. Encourages dynamic growth opportunities.
  1. Finds unique ways to go around barriers to success.
  1. Takes the initiative to complete tasks.
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. Ensures others follow the correct rules and regulations on fiscal matters.
  1. Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
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.