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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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
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.
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Safety

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. Participates in safety training when offered.
  1. Mitigates hazards and safety issues that arise.
  1. Develops safety guidelines for the department.
  1. Creates accurate and effective measures of safety.
  1. Performs work safely.
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. Seeks opportunities to grow in skills and knowledge.
  1. Pursues self-improvement through continual learning.
  1. Improves on their skill sets.
  1. Takes the initiative to learn new skills.
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. Visibly supports and encourages diversity in style and background.
  1. Works to eliminate unnecessary work or barriers that get in others' way.
  1. Treats all people fairly and with respect.
  1. Contributes to a positive and fun work environment.
  1. Is gracious and professional in their interactions with others.
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. Functions well under stress, deadlines, and/or significant workloads.
  1. Maintains focus when handling several problems or tasks simultaneously.
  1. Makes sure that employees understand how their work relates to organizational goals.
  1. Excellent at managing time.
  1. Helps guide employees with prioritizing tasks.
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. Has excellent influencing/negotiating skills.
  1. Seeks to obtain consensus or compromise.
  1. Communicates effectively with others.
  1. Develops a good rapport with others.
  1. Understanding what others need.
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. Able to balance the needs of different people in a solution to a problem.
  1. Analyzes systems and processes for opportunities to gain efficiency.
  1. Uses data analytics to identify patterns and trends that may indicate emerging issues.
  1. Gets accurate information about what went wrong.
  1. Able to conduct a thorough Critical Incident interview.
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. Integrates developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
  1. Ranks the importance of tasks to make sure critical tasks are completed first.
  1. Can multitask while performing all of their other responsibilities and activities.
  1. Observes, analyzes, and responds to merchandise needs while serving customers and accomplishing operational tasks.
  1. Assesses current capabilities before committing to new requests from customers.
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. Encourages commitment in others to obtain results.
  1. Creates a sense of urgency among the store team members to complete activities, which drive sales.
  1. Coordinates all department activities into a cohesive team effort.
  1. Willing to do whatever it takes-not afraid to have to put in extra effort.
  1. Able to focus on a task even when working alone.
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. Makes sure employees understand why they were given certain assignments.
  1. Communicates ideas and facts clearly and effectively in writing.
  1. Clarifies problems and their causes to help employees correct them.
  1. Clearly defines work objectives for employees.
  1. Writes clear job descriptions for positions in the organization.
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. Is above average in addressing the needs of the clients.
  1. Anticipates client needs.
  1. Provides a responsive service that meets the needs of clients.
  1. Follows up with any unanswered questions from the client.
  1. Is honest in all communication with the clients.
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 how decisions impact other business units beyond their immediate department of work group.
  1. Impresses upon others the important aspects of [Company].
  1. Understands the "basics" as to how [Company] functions/operates.
  1. Follows existing procedures and processes.
  1. Attends [Company] gatherings and social events.
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.