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)

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

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 a great company.

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

Overall, please rate the effectiveness of .

5- Very Effective

4- Effective

3- Neither

2- Ineffective

1- Very Ineffective
Strengths
Areas for Development
Please give any final comments or suggestions for 's assessment.

Safety	Does Not Exhibit this Competency	Seldom Exhibits this Competency	Sometimes Exhibits this Competency	Usually Exhibits this Competency	Always Exhibits this Competency
Encourages others to attend safety training.
Develops a culture of safety.
Develops safety guidelines for the department.
Ensures that all supervisors are aware of regulatory and compliance measures.
Performs 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 Exhibits this Competency	Usually Exhibits this Competency	Always Exhibits this Competency
Encourages employees to produce the best quality products.
Encourages others to produce the highest quality work products.
Corrects issues in a timely manner.
Encourages others to achieve high quality standards.
Analyze what occurred and re-adjusts accordingly when goals are not met.
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
Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
Analyzes interpersonal problems instead of reacting to them.
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
Deals effectively with employee grievances.
Assists team members by helping them see the other point of view.
Discusses conflict situations with supervisor.
Identifies and takes steps to prevent potential confrontations.
Tries to understand others' point of view before making judgments
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
Takes responsibility for things that go wrong
Delegate tasks effectively
Sets an example for others to follow
Is ready to offer help
Makes you feel enthusiastic about your work
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
Uses appropriate techniques to solve problems.
Analyzes data and information from several sources and arrives at logical conclusions.
Can effectively interpret and analyze data.
Asks the "right" questions to size up or evaluate situations.
Actively seeks constructive feedback from others.
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
Is proactive and takes steps to prepare for changes in the workplace.
Is flexible and open minded in dealing with others.
Develops insights and applies innovative solutions to projects and problems.
Willing to change ideas or perceptions based on new information or contrary evidence which is presented.
Learns from personal experiences and/or mistakes.
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
Does not become distracted by non-issues or interruptions.
Explains the "whys" behind organizational objectives
Works toward achievement of goals even when confronted with obstacles.
Demonstrates the personal confidence to "stay the course," even when faced with difficulty
Directs team in prioritizing daily work activities
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
Considers customers point of view when making decisions.
Maintains positive customer relationships.
Consistently models positive customer service attitudes.
Develops good rapport and trust with the customer.
Asks questions and listens carefully to determine customer needs and to ensure that the customer's needs are met.
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
Aligns personal vision with global strategies.
Applies knowledge of overseas markets.
Sets the example for team on importance of cultural awareness.
Analyzes global issues/problems that are having a large impact on the Company.
Considers customers point of view when making decisions.
Please feel free to provide any comments to help explain your answers?