HR-Survey > 360-Degree Feedback > Competency Model > Safety Skills

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)
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.






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. Works to implement corrective safety measures.
  1. Is aware of OSHA safety guidelines.
  1. Develops a sustainable safety culture.
  1. Points out behaviors in others that may be unsafe.
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. Systematically and thoroughly inspects products for consistency in meeting specifications.
  1. Develops a quality manual to assist in troubleshooting issues and documenting the quality management system.
  1. Ensures high consistency across batches or production runs.
  1. Influences others to achieve high quality standards.
  1. Reflects on what is working and what could be improved.
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. Consciously controls own negative emotions in order to keep team morale up.
  1. Uses patience and self-control in working with customers and associates.
  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.
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. Facilitates constructive dialog with stakeholders.
  1. Achieves mutually acceptable solutions through collaborative efforts by both parties.
  1. Establishes roles and responsibilities of team members.
  1. Seeks to achieve mutually acceptable outcomes.
  1. Acknowledges each party's intrinsic needs.
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. Keep staff informed about what is happening in the company
  1. Makes you feel enthusiastic about your work
  1. Delegate tasks effectively
  1. Sets an example for others to follow
  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. Identifies problems and issues needing resolution.
  1. Analyzes issues and reduces them to their component parts.
  1. Identifies opportunities for progress and innovation.
  1. Selects the appropriate techniques for analysis.
  1. Identifies the root cause of a problem.
Please feel free to provide any comments to help explain your answers?

Adaptability

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
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Competency
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Competency
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Competency
  1. Continually trying to improve skills to remain current.
  1. Will stop what they are doing to help colleagues in need.
  1. Adjusts to new plans and procedures.
  1. Able to step in and help co-workers when needed.
  1. Handles unexpected events without a loss of productivity.
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. Achieves high levels of performance.
  1. Highly motivated to complete tasks despite obstacles that may arise.
  1. Identifies what needs to be accomplished.
  1. Encourages a high-energy, fun work environment and coaches others on how to do the same
  1. Helps the team maintain focus on the goals.
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
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Competency
Always
Exhibits this
Competency
  1. Focuses on providing excellent customer service.
  1. Is honest in all communication with the customers.
  1. Actively listens to concerns from customers.
  1. Tailors innovative products for each customer.
  1. Develops good rapport and trust with the customer.
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. Communicates effectively on a multi-lingual basis.
  1. Works well with others from different cultural backgrounds.
  1. Sets the example for team on importance of cultural awareness.
  1. Demonstrates a curiosity about diverse individuals and cultures.
  1. Facilitates open communication with individuals from other countries.
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.