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
Determines when and where safety incidents occur.
Reviews incident and near-miss data to identify environmental factors contributing to risk.
Provides effective safety and health training to new employees.
Ensures all employees handling hazardous materials are properly trained.
Performs a safety analysis of jobs in the department.
Time Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Avoids distractions in the workplace.
Schedules work based on peak productivity periods to enhance focus and output.
Organizes work responsibilities for maximum efficiency.
Approaches work with a sense of urgency.
Manages work time and family life to bring both into balance.
Self Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Project Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Communicates with the teams often to ensure that the deadlines are met.
Meets with stakeholders to determine the requirements for the project.
Correctly estimates the cost of supplies for the project.
Estimates the duration for each phase of the project.
Researches potential solutions to meet the constraints of the project.
Conflict Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Celebrates breakthroughs that arise from difficult conversations, reinforcing the value of constructive conflict.
Persuades others to accept personal transformation.
Discusses conflict situations with supervisor.
Tries to understand others' point of view before making judgments
Encourages teams to extract lessons from conflict and apply them to improve processes, relationships, or strategy.
Decision Making	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Employs sound judgment and logical reasoning.
Invites input from peers or stakeholders to understand the impact and improve decision-making processes.
Stays true to values and ethical standards even when decisions are difficult or unpopular.
Is aware of the impact of decisions and informs others about potential outcomes.
Receptive to new ideas from others when making decisions.
Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Stays committed to goals even when progress is slow.
Takes preemptive actions avoid obstacles or delays.
Works quickly to get the job done.
Takes the initiative and does not wait for the situation to change.
Works across organizational lines and boundaries to attain goals.
Regulatory/Compliance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Follows up on any unresolved compliance issues.
Establishes protocols for secure data transmission between departments and external regulators.
Identifies and assesses areas of regulatory or compliance risk.
Offers training to employees to ensure they comply with regulations.
Performs regular compliance audits.
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Collaborates with others to accomplish goals and objectives.
Contacts possible partners to seek new opportunities.
Guarantees equitable and fair treatment for all network participants.
Is aware of the location/availability of resources within the network.
Uses new techniques and procedures learned through established networks of professionals.
Strategic Insight	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Develops a strategic vision for the future.
Educates team members on emerging trends and their implications for current projects or goals.
Communicates with employees to find out their needs.
Analyzes unique issues or problems impacting the Company.
Adjusts strategic plans based on insights gathered from different points of view.

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

    -Excellent -Good -Average -Poor




47. Would you refer others who are seeking employment to [Company]?
    Yes No
    
    Please provide explanation:
    
    
    
48. 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?
    
    
    
49. What changes do you see [Company] making in order to raise the standards?
    
    
    
50. I feel good about my continued employment with [Company].
    Yes No
    
    If no, please provide explanation:
    
    
    
51. What do you like best about working for [Company]?
    
    
    
52. 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: