Safety - 360 Degree Feedback Survey Sample #3





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 asked to evaluate yourself as part of a 360-degree feedback process. Other employees, including your manager(s), peers, and direct reports will also evaluate you. In this manner, you will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of your performance as a manager. The objective is to provide you with feedback so as to allow you to improve your performance, resulting in improved team performance, and organizational effectiveness.

If you are not able to respond to an item, leave it blank and go on to the next item.

Competencies Included:
Safety, Quality, Self Management, Conflict Management, Management, Analytical, Adaptability, Results Oriented, Customer Focus, Global Perspective
Sample Result Document:
Sample Results
We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

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






Safety

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Commits adequate resources toward safety measures.
  1. Develops a culture of safety.
  1. Performs work safely.
  1. Ensures that all supervisors are aware of regulatory and compliance measures.
  1. Develops a strong safety culture.
Please feel free to provide any comments to help explain your answers?

Quality

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Ensures the hiring of employees that have a quality focus.
  1. Assesses strengths and weaknesses of various quality initiatives.
  1. Successfully implements quality controls within the department.
  1. Creates effective policies regarding quality of services and products.
  1. Recognizes their role in promoting quality and safety in the workplace.
Please feel free to provide any comments to help explain your answers?

Self Management

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
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Competency
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Competency
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Exhibits this
Competency
  1. Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
  1. Uses patience and self-control in working with customers and associates.
  1. Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
  1. Analyzes interpersonal problems instead of reacting to them.
  1. Steps away from a situation to process appropriate response.
Please feel free to provide any comments to help explain your answers?

Conflict Management

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
Exhibits this
Competency
Usually
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Competency
Always
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Competency
  1. Helps to maintain dignity of all persons involved.
  1. Deals effectively with employee grievances.
  1. Tries to understand others' point of view before making judgments
  1. Works to settle conflicts in a manner that is acceptable for a long-term solution.
  1. Identifies areas of agreement and common ground to form basis of resolution.
Please feel free to provide any comments to help explain your answers?

Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
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Competency
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Exhibits this
Competency
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Competency
  1. Takes responsibility for things that go wrong
  1. Keep staff informed about what is happening in the company
  1. Delegate tasks effectively
  1. Is ready to offer help
  1. Sets an example for others to follow
Please feel free to provide any comments to help explain your answers?

Analytical

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
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Competency
Usually
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Competency
Always
Exhibits this
Competency
  1. Prioritizes various actions to be taken when solving a problem.
  1. Asks the "right" questions to size up or evaluate situations.
  1. Identifies opportunities for progress and innovation.
  1. Analyzes issues and reduces them to their component parts.
  1. Balances risks and costs with the rewards and probabilities of success when decisions.
Please feel free to provide any comments to help explain your answers?

Adaptability

Does Not
Exhibit this
Competency
Seldom
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Competency
Sometimes
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Competency
Usually
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Competency
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Exhibits this
Competency
  1. Adjusts plans to meet the needs of new constraints.
  1. Works effectively in dynamic and changing work environments.
  1. Easily accepts new responsibilities.
  1. Able to adjust to changes as needed.
  1. Able to work effectively with new people and new teams.
Please feel free to provide any comments to help explain your answers?

Results Oriented

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
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Competency
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Exhibits this
Competency
  1. Makes changes to the plans if it will result in increased output.
  1. Sets important goals for the department.
  1. Creates measures of performance to track progress.
  1. Sets the objectives for the team.
  1. Provides clear expectations for employees.
Please feel free to provide any comments to help explain your answers?

Customer Focus

Does Not
Exhibit this
Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. Tailors innovative products for each customer.
  1. Manages customer accounts with high degree of competence.
  1. Accepts responsibility for ensuring customer satisfaction.
  1. Looks for opportunities that have a positive impact on customers.
  1. Has excellent communication with customers.
Please feel free to provide any comments to help explain your answers?

Global Perspective

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
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Competency
  1. Works well with others from different cultural backgrounds.
  1. Attends training seminars and conferences to increase skills in working with others globally.
  1. Engages in problem solving with individuals outside of the country.
  1. Builds working relationships with others across cultures.
  1. Is aware of the culture, behaviors, identities and beliefs of others.
Please feel free to provide any comments to help explain your answers?

  1. Overall, please rate the effectiveness of [Participant Name].






  2. Strengths


  3. Areas for Development


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