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Juggling Multiple Responsibilities - 360 Degree Feedback Survey Sample #5





360-Degree Assessment 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)
Dear Employee:

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the Closing Comments section. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

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 by .

Thank you for your participation in the survey.

Management Team



Juggling Multiple Responsibilities

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Organizes tasks for the most efficient order of completion.
  1. Coordinates the work of a team by assigning tasks to other team members.
  1. Builds in extra time in the schedule for unplanned events/occurrences.
  1. Keeps track of multiple assignments and deadlines.
  1. Ensures that assignments are prioritized according to the needs of the department/company.


Empowering Others

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Encourages employees to solve problems on their own.
  1. Allows employees to make their own decisions.
  1. Is aware of the skill levels of others.
  1. Supports the decisions of others.
  1. Is aware of the skill levels of employees and assigns tasks that are at the appropriate skill level.


Developing Others

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Encourages employees through recognition of positive changes in behavior.
  1. Supports the successes of other employees.
  1. Assesses employees' developmental needs.
  1. Assigns tasks and responsibilities to develop skills of others.
  1. Develops employees by offering and encouraging them to take on new or additional responsibilities.


Others

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Helpful
  1. Respects the opinions of other employees.
  1. Treats others with respect and dignity.
  1. Works effectively with people from other departments.
  1. Is able to see issues from others' perspectives.


Strategic Focus

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Communicates goals and objectives to employees.
  1. Understands & contributes to development of strategic goals.
  1. Looks for opportunities to enhance contributions to the bottom line.
  1. Monitors performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
  1. Creates plans to develop and promote organizational and area strengths, as well as to address weaknesses.


Fiscal Management

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Ensures others follow the correct rules and regulations on fiscal matters.
  1. Monitors expenses and verifies the need for items purchased.
  1. Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
  1. Develops budgets and plans for various programs and initiatives.
  1. Effective in using Company's resources.


Vision

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. Persuades others to follow the Company's vision.
  1. Communicates a vision of where the Company needs to be in the future.
  1. Clearly articulates a vision for his/her work and inspires others to support it
  1. Expresses the Company vision in a way that is easily understood and adopted by employees.
  1. Demonstrates consistency between words and actions



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






  2. Strengths


  3. Areas for Development


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