Juggling Multiple Responsibilities - 360 Degree Feedback Survey Sample #11

360 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)

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 comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing 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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

Juggling Multiple Responsibilities

What does Juggling Multiple Responsibilities mean?
It means that ...
  • You organize tasks for the most efficient order of completion.
  • You assign tasks based on skills of team members.
  • You ensure that assignments are prioritized according to the needs of the department/company.
  • You spend the most time and effort on critical tasks first.
  • You determine which tasks are critical and which tasks are optional.

To what extent does this person exhibit Juggling Multiple Responsibilities?
Select from one of the ratings below.


What does Initiative mean?
It means that ...
  • You engage with new customers immediately.
  • I inform the manager of any important changes in the equipment operation.
  • You immediately work to complete goals well before your deadline.
  • I encourage others on the team to suggest process improvements.
  • I immediately work on solving problems.

To what extent does this person exhibit Initiative?
Select from one of the ratings below.


What does Excellence mean?
It means that ...
  • You take a lot of pride in your work.
  • You keep yourself and others focused on constant improvement.
  • You produce high quality work.
  • You demonstrate the analytical skills to do your job.
  • You can be counted on to add value wherever you are involved.

To what extent does this person exhibit Excellence?
Select from one of the ratings below.


What does Teamwork mean?
It means that ...
  • You actively participates as a team member
  • You coach team on how to solve problems, plan, and meet organizational goals and objectives.
  • You willingly share your technical expertise
  • You coach team members
  • You seek and listen to other's contributions

To what extent does this person exhibit Teamwork?
Select from one of the ratings below.

Supervisory Skills

What does Supervisory Skills mean?
It means that ...
  • I understand the importance of good performance management.
  • You are respectful toward employees.
  • I use the team to its fullest capacity.
  • I schedule follow up meetings if employee's performance is below average.
  • I am a calming force during stressful periods.

To what extent does this person exhibit Supervisory Skills?
Select from one of the ratings below.

Areas for Development

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