Safety - 360 Degree Feedback Survey Sample #4

Dear Employee:


Welcome to our 360-Degree Feedback Assessment of [Participant Name]. Our objective is to provide feedback which will help advance his/her leadership skills and capabilities. We are asking you to take time to respond to this survey to help us identify where we are doing well and where we have opportunities to do better.

We have developed this survey with questions tailored for [Participant Name]'s position in the department to provide you with an opportunity to anonymously rate many facets of his/her leadership performance. The survey will assess what you value most in their leadership skills and allow you to make positive suggestions for improvement.

Please be honest, constructive and thoughtful in your responses. The results of this survey will be used to help drive our future success. If you have any questions about the process please contact [Contact Person].

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

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team



Instructions:
Please complete the items below and press the submit button at the end of the survey. If you need multiple sessions to complete the survey, please click the "Submit" button at the end of each session to save your responses. Please feel free to skip any items that you do not wish to respond to. Keep in mind that your responses help us to become a better place to work. So, you are encouraged to respond to all items on the questionnaire.

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Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Encourages others to attend safety training.
Works to implement corrective safety measures.
Develops a culture of safety.
Ensures compliance with safety regulations.
Is not afraid to question a potential safety issue observed in the workplace.
Time Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Delegates routine tasks to team members, allowing the manager to concentrate on more strategic or complex responsibilities.
Uses batch processing to accomplish many similar tasks simultaneously.
Arrives to (attends) meetings on time.
Allocates time to the highest priority items.
Approaches work with a sense of urgency.
Self Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Is aware of personal impact on others and adjusts behavior to create a positive leadership presence.
Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
Does not allow own emotions to interfere with the performance of others.
Uses patience and self-control in working with customers and associates.
Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
Project Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Identifies critical requirements for each phase of the project.
Inspires the project implementation team to achieve success.
Ensures work is completed to the appropriate standards.
Holds meetings with supply-chain vendors regarding acquisition of resources.
Plans who, when, and what work needs to get done.
Conflict Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Encourages both sides to make compromises to resolve the conflict.
Prepares team members to accept differing view points.
Persuades others to accept personal transformation.
Attempts to accommodate vital interests of those who felt alienated or suffered injustice.
Promotes a culture that values diverse perspectives.
Decision Making	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Makes decisions independently (without having to be told what or how).
Breaks complex issues into manageable parts and organizes them in a systematic way before making decisions
Carefully evaluates information before making an important decision.
Willing to change their strategy if new information arises.
Is confident in the decisions they make.
Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Is proactive in addressing the needs of the department.
Takes the initiative to address problems sooner rather than later.
Takes action in critical situations.
Completes challenging projects successfully despite setbacks.
Overcomes obstacles that may impede progress on a task.
Regulatory/Compliance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Strengthens employees' ability to appropriately handle compliance and ethics issues.
Keeps track of changes in legislation affecting regulatory compliance.
Coordinates with legal counsel in conducting audits of legal compliance.
Develops a confidential reporting system to enable employees to anonymously report safety violations.
Coordinates the execution of compliance strategies across departments.
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Can perform a risk assessment to show a balanced view of the partnership's potential outcomes.
Strengthens the contacts with other departments.
Develops networks and builds alliances.
Facilitates communication with others in the company.
Creates opportunities and incentives for employees to learn and share knowledge with others.
Strategic Insight	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Ensures that the department's goals are strategically aligned with the company's goals.
Lets employees know how their roles contribute toward the achievement of strategic company objectives.
Identifies root causes of problems.
Anticipates business cycles and trends and makes adjustments in a timely manner.
Creates strategies that significantly benefit the Company.

51. On a scale of Excellent to Poor, how would you rate your overall employment with [Company] and why?
    

    -Excellent -Good -Average -Poor




52. Would you refer others who are seeking employment to [Company]?
    Yes No
    
    Please provide explanation:
    
    
    
53. If you had an opportunity to make any change you wanted to make [Company] a better place to work, what one improvement would you make?
    
    
    
54. What changes do you see [Company] making in order to raise the standards?
    
    
    
55. I feel good about my continued employment with [Company].
    Yes No
    
    If no, please provide explanation:
    
    
    
56. What do you like best about working for [Company]?
    
    
    
57. What do you like least about working for [Company]? How could it be improved?
    
    
    
93. Use the space below to enter any final comments you would like to be noted: