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)

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.

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. Maintains self-confidence and a positive mental attitude while facing challenging peaks and valleys of activities.
  1. Can multi-task while performing all of their other responsibilities and activities.
  1. Assesses current capabilities before committing to new requests from customers.
  1. Integrates developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
  1. Bounces back from daily crisis, disappointments and frustrations.

Bias for Action

Agree Unsure Disagree N/A
  1. Coach others to foster an environment which can adapt quickly and willingly to rapid change.
  1. Completes a large volume of work.
  1. Encourages risk taking and experimentation to improve performance
  1. Completes work on time
  1. Identifies ways to simplify work processes and reduce cycle times


Agree Unsure Disagree N/A
  1. Works toward achieving established goals and objectives.
  1. Assures [Company] principles are understood, employed & pursued.
  1. Consistently provides me with timely feedback for improving my performance.
  1. Encourages me to take on greater responsibility.
  1. Able to organize work.


Agree Unsure Disagree N/A
  1. Behavior is ethical and honest.
  1. Acts as a resource without removing individual responsibility.
  1. ...takes personal responsibility for results.
  1. Works in a way that makes others want to work with her/him.
  1. Sets a good example

Business Acumen

Agree Unsure Disagree N/A
  1. Asks the 'right' questions to size up or evaluate situations.
  1. Able to align resources to meet the business needs of the company.
  1. Considers impact of actions on other areas of the organization.
  1. Understands complex issues and problems.
  1. Effectively develops and uses resources (people, time, money, supplies, equipment, and space) to improve organizational performance

Continual Learning

Agree Unsure Disagree N/A
  1. Builds on their strengths while addressing their weaknesses.
  1. Shares best practices with others and learns from others.
  1. Pursues self-improvement through continual learning.
  1. Sets relevant learning objectives and goals.
  1. Grasps new ideas, concepts, technical, or business knowledge.


Agree Unsure Disagree N/A
  1. Actively seeks feedback from others.
  1. Open to the suggestions of others.
  1. Is visible and approachable.
  1. Accepts the views of others.
  1. Seeks feedback to enhance performance.


Agree Unsure Disagree N/A
  1. Works to eliminate unnecessary work or barriers that get in others' way.
  1. Contributes to a positive and fun work environment.
  1. Visibly supports and encourages diversity in style and background.
  1. Shows by their actions that they trust in the positive intentions of others.
  1. Builds open and trusting relationships.


Agree Unsure Disagree N/A
  1. Understands & contributes to development of strategic goals.
  1. Achieves established goals.
  1. Makes sure that team members have a clear idea of our group's goals.
  1. Achieves goals.
  1. Establishes and documents goals and objectives.

Change Management

Agree Unsure Disagree N/A
  1. Addresses organizational and departmental resistance to changes.
  1. Works cooperatively with others to implement changes.
  1. Effective in dealing with ambiguous and challenging situations.
  1. Supports the Company's efforts to implement changes.
  1. Adopts changes to set and example for others to follow.


Agree Unsure Disagree N/A
  1. Willingly shares information and expertise; sought out as resource by others
  1. Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices
  1. Demonstrates mastery of the technical competencies required in his/her work.
  1. Knows how to produce high quality products/work.
  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.


Agree Unsure Disagree N/A
  1. Maintains infrastructure to support partnerships and networks.
  1. Builds alliances between departments and teams.
  1. Supports a partnering/networking culture.
  1. Creates the conditions for partnerships to grow and develop.
  1. Seeks an understanding of diverse functions within the Company.

Strategic Insight

Agree Unsure Disagree N/A
  1. Analyzes records and reports to obtain insight into potential issues and trends.
  1. Maintains knowledge of current trends in the industry.
  1. Formulates policies and strategies for addressing the Company's important challenges.
  1. Communicates vision for the department and company.
  1. Analyzes unique issues or problems impacting the Company.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

  4. Please give any final comments or suggestions for 's assessment.