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)
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


Safety

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. You ensure compliance with safety regulations.
  1. You develop safety guidelines for the department.
  1. You develop a strong safety culture.
  1. You participate in safety training as applicable.
  1. You keep accurate safety records.
  1. You identify and addresses safety needs.
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. I take responsibility for meeting performance standards.
  1. I take action to respond to dissatisfied customers.
  1. I am proactive in addressing the needs of the department.
  1. You work quickly to get the job done.
  1. You make effective decisions
  1. I move forward on important projects.
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 respond to requests for information in a timely manner.
  1. You conduct appointments at scheduled start time.
  1. You invoice clients on a timely basis.
  1. You avoid making personal phone calls during working hours.
  1. You start the workday when scheduled.
  1. You arrive to meetings on time.
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 analyze issues and reduce them to their component parts.
  1. You implement data validation techniques and methods.
  1. You balance risks and costs with the reward and probabilities of success when decisions.
  1. You use appropriate techniques to solve problems.
  1. You ask the "right" questions to size up or evaluate situations.
  1. You analyze data and information from several sources and arrives at logical conclusions.
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 conceive, implement and evaluate ideas.
  1. You create a lot of new ideas.
  1. You are creative and inspirational.
  1. You add value to the department/organization.
  1. You inspire creativity in your team.
  1. You are creative.
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. You strive to meet goals and objectives.
  1. You set challenging goals for the department.
  1. You accept setbacks and challenges as improvement opportunities
  1. You complete work to a high technical standard
  1. You follow-up and take action when goals are not met to ensure better results in the future.
  1. I work to meet required benchmarks for the position.
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 help employees to maintain high personal standards.
  1. You meet regularly with employees to coach them on areas that will enhance your performance
  1. You provide clear, motivating, and constructive feedback.
  1. You address employee behavior problems effectively.
  1. You help employees to understand responsibilities, authority, and expectations.
  1. You coach employees in how to strengthen knowledge and skills to improve work 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. I recognize trends in underlying data.
  1. You effectively develop and use resources (people, time, money, supplies, equipment, and space) to improve organizational performance
  1. I collect valuable customer insights to ensure our services meet their needs.
  1. I establish key performance indicators (KPIs) to measure progress and success.
  1. You understand complex issues and problems.
  1. You understand and apply business and financial principles.
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 are aware of other organizational cultures to compare/contrast with the current organizational culture.
  1. You anticipate problems that may affect the department.
  1. You are able to use corporate politics to advance department objectives.
  1. You understand departmental policies and procedures.
  1. You understand the current organizational culture.
  1. You are effective in communicating with others within the organization.
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.