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



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Safety

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Identifies predictable hazards in the workplace.
  1. Performs work safely.
  1. Seeks to reduce the likelihood of accidents.
  1. Develops a culture of safety.
  1. Encourages others to work safely.
Please feel free to provide any comments to help explain your answers?

Quality

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
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Competency
Usually
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Competency
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Competency
  1. Provides advice and guidance to team members on improving quality controls.
  1. Always strives to produce the highest quality work products.
  1. Develops specific quality standards/goals to be met within a specified timeframe.
  1. Establishes timeframes for achieving suitable quality levels.
  1. Adopts and implements best practices when it comes to quality procedures.
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
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Competency
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Competency
  1. Consciously controls own negative emotions in order to keep team morale up.
  1. Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
  1. Analyzes interpersonal problems instead of reacting to them.
  1. Steps away from a situation to process appropriate response.
  1. Does not allow own emotions to interfere with the performance of others.
Please feel free to provide any comments to help explain your answers?

Conflict Management

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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  1. Prevents minor issues from escalating into major problems.
  1. Works with others as needed to facilitate resolution of conflicts.
  1. Facilitates both parties in collaboratively seeking a compromise.
  1. Addresses concerns about the availability of limited resources.
  1. Works to reduce misunderstandings and poor communication.
Please feel free to provide any comments to help explain your answers?

Management

Does Not
Exhibit this
Competency
Seldom
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Competency
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Competency
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  1. Delegate tasks effectively
  1. Makes you feel enthusiastic about your work
  1. Takes responsibility for things that go wrong
  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
Exhibits this
Competency
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Competency
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Competency
  1. Collects relevant data and facts about a situation.
  1. Reviews contractual documents for clauses and specifications to ensure binding agreements are free from disputes.
  1. Examines how the new software will affect workflows, employee morale, customer interactions, and long-term scalability.
  1. Able to recall relevant information when needed.
  1. Identifies trends and patterns in data can lead to valuable insights and strategic decisions.
Please feel free to provide any comments to help explain your answers?

Adaptability

Does Not
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Competency
Seldom
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Competency
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Competency
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Competency
  1. Adjusts plans to meet the needs of new constraints.
  1. Adapts to changes in team membership.
  1. Is open to changes in policies and procedures.
  1. Able to adapt to changes in technology and processes.
  1. Adjusts to new plans and procedures.
Please feel free to provide any comments to help explain your answers?

Results Oriented

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. Stays focused on solving problems and getting work done.
  1. Sets objectives for the department.
  1. Identifies what needs to be accomplished.
  1. Motivated by a strong desire to exceed performance standards.
  1. Completes all required coursework.
Please feel free to provide any comments to help explain your answers?

Customer Focus

Does Not
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Competency
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Competency
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Competency
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Competency
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Competency
  1. Creates documents that meet the customer's specifications.
  1. Responds to the needs of the customer.
  1. Views customer satisfaction as an everyday priority.
  1. Prioritizes the needs and preferences of the customer.
  1. Uses feedback from the customer to help improve the customer's experience.
Please feel free to provide any comments to help explain your answers?

Global Perspective

Does Not
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Competency
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Competency
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Competency
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Competency
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Exhibits this
Competency
  1. Excellent communication skills to conduct effective business with individuals from different cultures and/or countries.
  1. Cooperates with others on a global scale.
  1. Develops both the cultural awareness and business skills to grow our business in all countries, and work effectively across borders with employees, customers, and shareowners.
  1. Understands and appreciates the perspectives offered by others with different cultural backgrounds.
  1. Demonstrates a curiosity about diverse individuals and cultures.
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.