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HR-Survey > 360-Degree Feedback > Competency Model > Safety Skills

Safety - 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Safety:
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 for Employees Participating in the 360-Feedback Assessment:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to receive feedback from a group of others. As part of this process, you will need to complete a self-assessment questionnaire at this time. Your feedback is an important part of our company's leadership development process and this survey 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 questions below, think about your experiences over the last 12 months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be combined with the responses received from others and a report will be generated for you to foster growth and on-going 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.

Competencies Included:
Safety, Action, Punctuality, Analytical, Creativity, Achievement, Coaching, Business Acumen, Organizational Fluency
Sample Result Document:
Sample Results
Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

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

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team
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Safety

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You conduct follow up safety inspections after critical incidents.
  1. I verify that employees consistently wear required PPE during all applicable tasks.
  1. You assess critical operations and identify resources need to maintain or restore them after a disaster.
  1. I monitor safety performance of departments.
  1. You develop a sustainable safety culture.
  1. You align people, processes, and practices to advance zero-injury goals.
If you were to make improvements in Safety, what are your suggestions for how you can improve this?

Action

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You drive and mobilizes others progress toward goals.
  1. I take proactive steps to address potential issues before they become a problem.
  1. You successfully make progress despite repeated failures or setbacks at work.
  1. You set high standards for yourself and others.
  1. I gladly accept new challenges and work on them with urgency.
  1. I use strategies to stay ahead of potential challenges at work.
If you were to make improvements in Action, what are your suggestions for how you can improve this?

Punctuality

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You start the workday when scheduled.
  1. You avoid making personal phone calls during working hours.
  1. You arrive to meetings on time.
  1. You conduct appointments at scheduled start time.
  1. You invoice clients on a timely basis.
  1. You respond to requests for information in a timely manner.
If you were to make improvements in Punctuality, what are your suggestions for how you can improve this?

Analytical

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You understand the basic principles of research.
  1. You determine if facts are consistent across multiple sources.
  1. I build complex financial models to project future revenues, expenses, and cash flows based on historical data and assumptions.
  1. You decompose complex information into smaller, manageable parts to understand the details better.
  1. You analyze data using statistical methods.
  1. I use cognitive skills or strategies that increase the probability of a desirable outcome.
If you were to make improvements in Analytical, what are your suggestions for how you can improve this?

Creativity

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You blend ideas from different domains to spark innovation.
  1. I bring a unique creative lens to problem-solving and planning.
  1. I consider problems from multiple angles to uncover new approaches.
  1. You identify opportunities to improve systems and processes.
  1. I think beyond immediate constraints to envision alternative paths.
  1. You are curious to find new solutions. asks questions such as "why?" and "what if?"
If you were to make improvements in Creativity, what are your suggestions for how you can improve this?

Achievement

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. I can complete training on the new equipment.
  1. You hold others to high standards of achievement.
  1. I move decisively in high-risk situations to secure long-term achievements.
  1. You take reasonable risks to achieve desired results.
  1. I promote a culture of process-driven success, empowering teams to perform at their highest potential.
  1. You execute tasks with precision and speed.
If you were to make improvements in Achievement, what are your suggestions for how you can improve this?

Coaching

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You ask employees to define or explain your goals, strategies, and motivations.
  1. You coach employees in how to strengthen knowledge and skills to improve work performance.
  1. I encourage the employee to see solving the issue as an opportunity to demonstrate their resourcefulness and resilience.
  1. You listen to subordinates thoughts, ideas, and input.
  1. You understand the individual differences in each employee including unique working style, stress threshold, and capacity for growth.
  1. You help employees achieve high performance.
If you were to make improvements in Coaching, what are your suggestions for how you can improve this?

Business Acumen

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You anticipate customer's business needs.
  1. I consider environmental, social, and governance (ESG) factors to ensure the business is sustainable in the long run.
  1. You understand the financial metrics used by the department.
  1. I analyze current business practices to make better informed decisions.
  1. I understand how strategic decisions impact constituents within the Company.
  1. You understand the "basics" as to how [Company] functions/operates.
If you were to make improvements in Business Acumen, what are your suggestions for how you can improve this?

Organizational Fluency

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You anticipate problems that may affect the department.
  1. You are able to explain departmental policies and procedures to others.
  1. You are aware of other organizational cultures to compare/contrast with the current organizational culture.
  1. You are able to deal with sensitive issues with tact and professionalism.
  1. You get things done through the department.
  1. You understand departmental policies and procedures.
If you were to make improvements in Organizational Fluency, what are your suggestions for how you can improve this?

  1. What are [Participant Name Here]'s greatest strengths demonstrated this year?


  2. What are [Participant Name Here]'s areas for development?


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