Juggling Multiple Responsibilities - 360 Degree Feedback Survey Sample #8

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)

You have been selected to provide feedback for the manager listed above. Your feedback is an important part of 's leadership development process. This tool 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 assessment form, please think about your experiences working with this individual during the last six to twelve months. Your responses will be merged with other people's feedback and presented to to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager.

Sample Result Document:
Sample Results
Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.

When clicking your selection below, try to best fit the manager's actual behaviors to the scale provided.

If you are not sure, or unable to assess, select "Not Applicable" (N/A) option.

Please complete your response by .

Juggling Multiple Responsibilities

Agree Unsure Disagree N/A
  1. Recognizes and responds to product placement and signing needs while staying alert to customers' needs, store activities and training associates.
  1. Organizes tasks for the most efficient order of completion.
  1. Assigns tasks based on skills of team members.
  1. Completes multiple tasks simultaneously.
  1. Determines which tasks are critical and which tasks are optional.

Bias for Action

Agree Unsure Disagree N/A
  1. Identifies ways to simplify work processes and reduce cycle times
  1. Completes a large volume of work.
  1. Seeks and utilizes opportunities for continuous learning and self-development.
  1. Encourages risk taking and experimentation to improve performance
  1. Completes work on time


Agree Unsure Disagree N/A
  1. Communicates goals and objectives to employees.
  1. Ability to establish realistic goals.
  1. Effectively organizes resources and plans
  1. Encourages me to take on greater responsibility.
  1. Assures [Company] principles are understood, employed & pursued.


Agree Unsure Disagree N/A
  1. Holds herself / himself accountable to goals / objectives
  1. Responsible for setting the vision of the department.
  1. Works in a way that makes others want to work with her/him.
  1. Behavior is ethical and honest.
  1. Sets a good example.

Business Acumen

Agree Unsure Disagree N/A
  1. Understands impacts of domestic & global market events & issues.
  1. Can effectively interpret and analyze data.
  1. Understands the dynamics of our industry.
  1. Applies the knowledge of work processes to influence the achievement of business goals
  1. Calculates return on investment (ROI) for various business projects.

Continual Learning

Agree Unsure Disagree N/A
  1. Is open to new ideas and concepts.
  1. Seeks opportunities to grow in skills and knowledge.
  1. Pursues self-improvement through continual learning.
  1. Grasps new ideas, concepts, technical, or business knowledge.
  1. Participates in regular training offered.


Agree Unsure Disagree N/A
  1. Seeks feedback to enhance performance.
  1. Accepts the views of others.
  1. Asks others for their ideas and opinions.
  1. Is easy to approach with ideas and opinions.
  1. Looks to others for input.


Agree Unsure Disagree N/A
  1. Works to eliminate unnecessary work or barriers that get in others' way.
  1. Builds open and trusting relationships.
  1. Is gracious and professional in their interactions with others.
  1. Treats all people fairly and with respect.
  1. Visibly supports and encourages diversity in style and background.


Agree Unsure Disagree N/A
  1. Goal Setting
  1. Understands & contributes to development of strategic goals.
  1. Achieves goals.
  1. Conducts timely follow-up; keeps others informed on a need to know basis.
  1. Achieves established goals.

Change Management

Agree Unsure Disagree N/A
  1. Able to get team members to change their attitudes.
  1. Inspires others to want to change.
  1. Adopts changes to set and example for others to follow.
  1. Assists others in understanding changes to the organization.
  1. Effective in dealing with ambiguous and challenging situations.


Agree Unsure Disagree N/A
  1. Willingly shares his/her technical expertise; sought out as resource by others
  1. Knows how to produce high quality products/work.
  1. Is knowledgeable of procedures or systems necessary for the job.
  1. Is naturally sought out by people outside his/her particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.
  1. Willingly shares information and expertise; sought out as resource by others


Agree Unsure Disagree N/A
  1. Builds alliances between departments and teams.
  1. Partners with peers to obtain influence within the Company.
  1. Capitalizes on partnerships and networks to enhance the Company's bottom line.
  1. Seeks to reduce institutional roadblocks to information sharing.
  1. Creates the conditions for partnerships to grow and develop.

Strategic Insight

Agree Unsure Disagree N/A
  1. Creates strategies that significantly benefit the Company.
  1. Identifies potential problems before they become critical incidents.
  1. Formulates policies and strategies for addressing the Company's important challenges.
  1. Formulates strategies and action plans to ensure successful completion of goals and objectives.
  1. Analyzes records and reports to obtain insight into potential issues and trends.

  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.