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Juggling Multiple Responsibilities - 360 Degree Feedback Survey Sample #3





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 asked to evaluate yourself as part of a 360-degree feedback process. Other employees, including your manager(s), peers, and direct reports will also evaluate you. In this manner, you will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of your performance as a manager. The objective is to provide you with feedback so as to allow you to improve your performance, resulting in improved team performance, and organizational effectiveness.

If you are not able to respond to an item, leave it blank and go on to the next item.

Competencies Included:
Juggling Multiple Responsibilities, Regulatory/Compliance, Partnering/Networking, Business Acumen, Communication Skills, Action, Emotional Intelligence, Management, Project Management, Delegation, Initiative, Strategic Insight, Global Perspective
Sample Result Document:
Sample Results
We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

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



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Juggling Multiple Responsibilities

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Determines which tasks are critical and which tasks are optional.
  1. Switches attention to more urgent tasks when necessary.
  1. Keeps track of multiple assignments and deadlines.
  1. Begins tasks as soon as possible.
  1. Avoids bottlenecks in progress by assigning multiple individuals to critical tasks.
Please feel free to provide any comments to help explain your answers?

Regulatory/Compliance

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Conducts necessary risk assessments.
  1. Maintains a state of readiness to address new and changing regulations and procedures.
  1. Ensures the company is in compliance with all laws regarding the production and transportation of product.
  1. Coordinates the work of other Business Managers to ensure all are in compliance with established standards and guidelines.
  1. Creates a standardized response protocol for responding to compliance related issues.
Please feel free to provide any comments to help explain your answers?

Partnering/Networking

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
Exhibits this
Competency
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Competency
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Competency
  1. Understands the potential risks/rewards of the partnership.
  1. Facilitates cross-functional collaboration and information sharing between various stakeholders.
  1. Communicates with others in an open manner.
  1. Forms strategic alliances with firms that specialize in areas that are complementary or help the company.
  1. Creates an environment that supports information exchange.
Please feel free to provide any comments to help explain your answers?

Business Acumen

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
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Competency
Always
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Competency
  1. Evaluates risks in terms of their business impact and likelihood of occurrence.
  1. Understands the financial metrics used by the department.
  1. Understands financial terminology, statements.
  1. Collects valuable customer insights to ensure our services meet their needs.
  1. Creates robust talent development programs through the identification of key skills gaps and future needs ensuring the company is able to meet its mission and vision.
Please feel free to provide any comments to help explain your answers?

Communication Skills

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
  1. Writes complete and developmentally-oriented performance appraisals with clear goals, using SMART criteria
  1. Communicates regularly with the department.
  1. Communicates effectively with colleagues and customers
  1. Notifies others about developments in plans and goals.
  1. Is an effective communicator
Please feel free to provide any comments to help explain your answers?

Action

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
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Competency
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Exhibits this
Competency
  1. Takes action when necessary.
  1. Immediately develops alternatives and solutions when presented with a problem or issue.
  1. Decides to act rather than remain passive.
  1. Uses strategies to stay ahead of potential challenges at work.
  1. Creates performance measures to ensure action by the department.
Please feel free to provide any comments to help explain your answers?

Emotional Intelligence

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
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Competency
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Competency
  1. Accurately perceives the emotional reactions of others.
  1. Is able to control their own emotions.
  1. Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
  1. Able to understand others' points of view.
  1. Is attentive to emotional cues and interprets others' feelings correctly.
Please feel free to provide any comments to help explain your answers?

Management

Does Not
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Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
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Exhibits this
Competency
Always
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Competency
  1. Maintains composure and professionalism when addressing performance issues or workplace tension.
  1. Correctly estimates the cost of supplies for projects.
  1. Evaluates employees' technical competencies and interpersonal strengths to delegate tasks aligned with their capabilities.
  1. Maintains momentum to meet deadlines for mission-critical work.
  1. Demonstrates emotional self-awareness and control when navigating tense or high-stakes situations.
Please feel free to provide any comments to help explain your answers?

Project Management

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
  1. Identifies risks to each phase of the project.
  1. Maps out the project, timeline, resource requirements, metrics and communication.
  1. Conducts a risk assessment for each phase of the project.
  1. Determines the roles for project team members.
  1. Engages with individuals internally and externally to support the implementation of the project.
Please feel free to provide any comments to help explain your answers?

Delegation

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
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Exhibits this
Competency
Always
Exhibits this
Competency
  1. Communicates expectations for assigned tasks.
  1. Distributes the workload evenly to the team members.
  1. Aware of the resources needed to complete tasks.
  1. Offers work that aligns with career aspirations.
  1. Assigns tasks to subordinates for completion.
Please feel free to provide any comments to help explain your answers?

Initiative

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
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Competency
Always
Exhibits this
Competency
  1. Is proactive when preparing for potential problems or critical events.
  1. Maintains momentum on long-term initiatives despite shifting priorities or limited support.
  1. Persists in stakeholder engagement even when initial outreach is met with resistance or indifference.
  1. Acts independently to solve pressing needs.
  1. Seeks and utilizes opportunities for continuous learning and self-development.
Please feel free to provide any comments to help explain your answers?

Strategic Insight

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
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Competency
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Competency
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Competency
  1. Develops a plan and strategy for each functional area within the mission statement.
  1. Recognizes unspoken concerns or morale issues through body language, tone, and team interactions.
  1. Analyzes unique issues or problems impacting the Company.
  1. Understands the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
  1. Creates a vision for the organization based on insights gathered from other companies in the industry.
Please feel free to provide any comments to help explain your answers?

Global Perspective

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. Forms strong client relationships with international partners.
  1. Creates an environment where individual differences are valued and supported.
  1. Accepts setbacks and challenges in foreign markets as improvement opportunities
  1. Able to listen and understand others and discuss issues in a respectful way.
  1. Understands and appreciates the perspectives offered by others with different cultural backgrounds.
Please feel free to provide any comments to help explain your answers?

  1. Overall, please rate the effectiveness of [Participant Name].






  2. Strengths


  3. Areas for Development


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