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. Encourages others to attend safety training.
  1. Participates in safety training when offered.
  1. Identifies predictable hazards in the workplace.
  1. Identifies and addresses safety needs.
  1. Is aware of OSHA safety guidelines.
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. Holds employees accountable for their quality of work.
  1. Always strives to produce the highest quality work products.
  1. Encourages others to achieve high quality standards.
  1. Reflects on what is working and what could be improved.
  1. Encourages others to produce the highest quality work products.
Please feel free to provide any comments to help explain your answers?

Self Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Steps away from a situation to process appropriate response.
  1. Analyzes interpersonal problems instead of reacting to them.
  1. Does not allow own emotions to interfere with the performance of others.
  1. Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
  1. Consciously controls own negative emotions in order to keep team morale up.
Please feel free to provide any comments to help explain your answers?

Conflict Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Discusses conflict situations with supervisor.
  1. Deals effectively with employee grievances.
  1. Tries to understand others' point of view before making judgments
  1. Assists team members by helping them see the other point of view.
  1. Identifies and takes steps to prevent potential confrontations.
Please feel free to provide any comments to help explain your answers?

Management

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

Analytical

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Implements data validation techniques and methods.
  1. Analyzes data and information from several sources and arrives at logical conclusions.
  1. Balances risks and costs with the rewards and probabilities of success when decisions.
  1. Analyzes issues and reduces them to their component parts.
  1. Uses appropriate techniques to solve problems.
Please feel free to provide any comments to help explain your answers?

Adaptability

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Able to adapt to changes in technology and processes.
  1. Is open to change and adjusts plans when needed.
  1. Adjusts to new plans and procedures.
  1. Flexible and open to new ideas and encourages others to recognize the value of change.
  1. Adapts quickly to new situations.
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
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Directs team in prioritizing daily work activities
  1. Quickly analyzes the situation to determine the most pressing needs.
  1. Motivated by a strong desire to exceed performance standards.
  1. Responds to changing events to maintain progress toward achieving results.
  1. Sets challenging goals to be achieved.
Please feel free to provide any comments to help explain your answers?

Customer Focus

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Uses feedback from customers to help improve services.
  1. Is pro-active in dealing with customers and addressing their needs.
  1. Anticipates resources needed to meet the customer needs.
  1. Gives feedback to the customer regularly.
  1. Is consistent in services provided to customers.
Please feel free to provide any comments to help explain your answers?

Global Perspective

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Demonstrates working knowledge of global transactions.
  1. Demonstrates a curiosity about diverse individuals and cultures.
  1. Can effectively deliver presentations to international clients.
  1. Forms strong client relationships with international partners.
  1. Comfortable using teleconferencing equipment to facilitate meetings with others abroad.
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.