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Juggling Multiple Responsibilities - 360 Degree Feedback Survey Sample #2





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

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 and the goals they were asked to achieve. 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 discussed with the employee to foster growth and on-going development.

Competencies Included:
Juggling Multiple Responsibilities, Results Oriented, Creativity, Professional Development, Punctuality, Quality, Goals, Clarity, Co-worker Development, Conflict Management, Planning
Sample Result Document:
Sample Results
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.

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

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Determines which tasks are critical and which tasks are optional.
  1. Observes, analyzes, and responds to merchandise needs while serving customers and accomplishing operational tasks.
  1. Assigns tasks based on skills of team members.
  1. Keeps track of multiple assignments and deadlines.
  1. Ranks the importance of tasks to make sure critical tasks are completed first.
What are your suggestions for how [Participant Name] can make improvements
in Juggling Multiple Responsibilities?

Results Oriented

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Excels in dynamic environments.
  1. Communicates expectations clearly and ensures alignment across roles.
  1. Tracks individual and team contributions against goals and communicates outcomes transparently.
  1. Creates a culture where commitments are honored and excuses are challenged respectfully.
  1. Adjusts timelines and deliverables in response to evolving stakeholder needs.
What are your suggestions for how [Participant Name] can make improvements
in Results Oriented?

Creativity

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Creates a lot of new ideas.
  1. Designs inventive solutions that improve efficiency or effectiveness.
  1. Works across departments to stimulate creative ideas.
  1. Fosters a creative culture that drives team engagement and productivity.
  1. Rethinks through solutions to find a better idea.
What are your suggestions for how [Participant Name] can make improvements
in Creativity?

Professional Development

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Quickly acquire and apply new knowledge and skills when needed
  1. Demonstrate enthusiasm and a willingness to learn new skills and knowledge
  1. Keep themselves up-to-date of technical/professional issues
  1. Seeks opportunities for continuous learning.
  1. Contributing fully to the extent of their skills
What are your suggestions for how [Participant Name] can make improvements
in Professional Development?

Punctuality

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Avoids making personal phone calls during working hours.
  1. Responds to requests for information in a timely manner.
  1. Maintains an efficient schedule of activities.
  1. Conducts appointments at scheduled start time.
  1. Starts the workday when scheduled.
What are your suggestions for how [Participant Name] can make improvements
in Punctuality?

Quality

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Effectively works with Quality Control (QC) engineers.
  1. Demonstrates a strong commitment to achieving quality goals.
  1. Creates and implements formal guidelines for quality controls.
  1. Addresses barriers to successfully implementing quality standards.
  1. Evaluates and improves the quality of services and products.
What are your suggestions for how [Participant Name] can make improvements
in Quality?

Goals

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Adheres to deadlines for the accomplishment of goals.
  1. Begins each coaching session with a determination of what goals should be achieved.
  1. Understands how personal goals are aligned with the broader vision and mission of the organization.
  1. Regularly tracks progress on meeting performance goals.
  1. Creates goals that are specific, measurable, and time-bound, ensuring that progress can be tracked and evaluated effectively.
What are your suggestions for how [Participant Name] can make improvements
in Goals?

Clarity

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Clearly defines work objectives for employees.
  1. Communicates ideas and facts clearly and effectively in writing.
  1. Provides a clear vision for the future.
  1. Uses appropriate grammar and tense in communications.
  1. Avoids stating unclear or conflicting goals.
What are your suggestions for how [Participant Name] can make improvements
in Clarity?

Co-worker Development

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Takes immediate action on poor performance
  1. Adapts coaching and mentoring approach to meet the style or needs of individuals
  1. Provides ongoing feedback to co-workers on their development progress
  1. Gives others development opportunities through project assignments and increased job responsibilities
  1. Sets and clearly communicates expectations, performance goals, and measurements to others
What are your suggestions for how [Participant Name] can make improvements
in Co-worker Development?

Conflict Management

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Possesses the necessary skills to manage conflict and relationships.
  1. Initates collaborative processes to reduce conflict.
  1. Encourages individuals to seek areas of common ground.
  1. Actively engages both parties to voluntarily collaborate and resolve their differences.
  1. Avoids being judgmental and micromanaging of employees.
What are your suggestions for how [Participant Name] can make improvements
in Conflict Management?

Planning

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Determines the amount of materials/supplies needed for the project.
  1. Adjusts plans as needed according to situational/strategic changes.
  1. Develops plans to help manage expectations and project demands.
  1. Understands the process for developing strategic plans for the organization.
  1. Able to develop logistics plans to move material through a multi-step supply chain.
What are your suggestions for how [Participant Name] can make improvements
in Planning?


  1. Strengths


  2. Areas for Development


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