Safety - 360 Degree Feedback Survey Sample #2





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

You have been selected to provide feedback on the employee listed above. 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 working with this employee over the last twelve months and the goals they were asked to achieve. 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 discussed with the employee to foster growth and on-going development.

Competencies Included:
Safety, Continual Learning, Attitude, Establishing Focus/Direction, Persuasion and Influence, Problem Solving, Juggling Multiple Responsibilities, Commitment To Result, Clarity, Client Focus, Company
Sample Result Document:
Sample Results
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.

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


Safety

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Develops a sustainable safety culture.
  1. Is aware of OSHA safety guidelines.
  1. Supports our company's safety programs.
  1. Works to implement corrective safety measures.
  1. Develops safety guidelines for the department.
What are your suggestions for how [Participant Name] can make improvements
in Safety?

Continual Learning

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Builds on their strengths while addressing their weaknesses.
  1. Improves on their skill sets.
  1. Pursues professional development opportunities when they arise.
  1. Grasps new ideas, concepts, technical, or business knowledge.
  1. Pursues learning that will enhance job performance.
What are your suggestions for how [Participant Name] can make improvements
in Continual Learning?

Attitude

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Works to eliminate unnecessary work or barriers that get in others' way.
  1. Builds open and trusting relationships.
  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. Treats all people fairly and with respect.
What are your suggestions for how [Participant Name] can make improvements
in Attitude?

Establishing Focus/Direction

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Makes sure that employees understand and identify with the team's mission.
  1. Functions well under stress, deadlines, and/or significant workloads.
  1. Stays focused even when under pressure and stress.
  1. Sets appropriate goals for employees.
  1. Excellent at managing time.
What are your suggestions for how [Participant Name] can make improvements
in Establishing Focus/Direction?

Persuasion and Influence

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Attempts to persuade others rather than simply control them.
  1. Seeks to obtain consensus or compromise.
  1. Persuades others to consider alternative points of view.
  1. Develops a good rapport with others.
  1. Has excellent influencing/negotiating skills.
What are your suggestions for how [Participant Name] can make improvements
in Persuasion and Influence?

Problem Solving

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Identifies fresh approaches and shows a willingness to question traditional assumptions.
  1. Skilled at quickly diagnosing issues, identifying root causes, and developing and implementing effective solutions in the workplace.
  1. Makes judgments based upon relevant information.
  1. Works cooperatively with others to solve problems.
  1. Finds creative ways to get things done with limited resources.
What are your suggestions for how [Participant Name] can make improvements
in Problem Solving?

Juggling Multiple Responsibilities

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Manages impact of increased traffic flow and freight receipt by detailed planning of controllables and by anticipating and reacting positively to uncontrollables.
  1. Keeps track of multiple assignments and deadlines.
  1. Recognizes and responds to product placement and signing needs while staying alert to customers' needs, store activities and training associates.
  1. Switches attention to more urgent tasks when necessary.
  1. Integrates developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
What are your suggestions for how [Participant Name] can make improvements
in Juggling Multiple Responsibilities?

Commitment To Result

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Coordinates all department activities into a cohesive team effort.
  1. Takes immediate action toward goals.
  1. Creates a sense of urgency among the store team members to complete activities, which drive sales.
  1. Committed to the team.
  1. Encourages commitment in others to obtain results.
What are your suggestions for how [Participant Name] can make improvements
in Commitment To Result?

Clarity

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Avoids creating ambiguity or mixed messages.
  1. Adjusts communication methods to the needs of the audience.
  1. Is clear about goals that need to be achieved.
  1. Avoids stating unclear or conflicting goals.
  1. Clearly explains the vision and goals of the company.
What are your suggestions for how [Participant Name] can make improvements
in Clarity?

Client Focus

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Provides a responsive service that meets the needs of clients.
  1. Responds to the needs of the client.
  1. Transparent in all communications with the client.
  1. Builds products that meet the unique needs of each client.
  1. Creates documents that meet the client's specifications.
What are your suggestions for how [Participant Name] can make improvements
in Client Focus?

Company

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Understands the "basics" as to how [Company] functions/operates.
  1. Understands the use of [Company] products and services.
  1. Attends [Company] gatherings and social events.
  1. Understands how decisions impact other business units beyond their immediate department of work group.
  1. Impresses upon others the important aspects of [Company].
What are your suggestions for how [Participant Name] can make improvements
in Company?


  1. Strengths


  2. Areas for Development


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