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
Develops a culture of safety.
Seeks to reduce the likelihood of accidents.
Commits adequate resources toward safety measures.
Points out behaviors in others that may be unsafe.
Supports safety programs and procedures.
Time Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Keeps and maintains a To-Do list.
Focuses on tasks that have high priority.
Completes tasks ahead of schedule.
Uses agendas when chairing or facilitating meetings.
Sets a good balance between work and family life.
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.
Uses patience and self-control in working with customers and associates.
Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
Steps away from a situation to process appropriate response.
Does not allow own emotions to interfere with the performance of others.
Project Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Anticipates potential problems and institutes controls and contingency plans to address them.
Regularly reviews project performance and goals.
Maintains costs and expenses within budget limits.
Develops performance measures for various aspects of the project.
Organizes, plans, and directs resources to accomplish the goals and objectives.
Conflict Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Discusses conflict situations with supervisor.
Helps employees to think through alternative ways to resolve conflict situations.
Identifies and takes steps to prevent potential confrontations.
Assists team members by helping them see the other point of view.
Clearly expresses expectations to others.
Decision Making	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Does not lose sight of the big picture when making decisions
Facilitates meetings with others to try to consider alternative courses of action.
Makes decisions that support the department's goals and objectives.
Uses reasonable assumptions and logic to decide between alternate courses of action
Makes decisions independently (without having to be told what or how).
Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Makes effective decisions, even when under pressure.
Gets the job done.
Drives and mobilizes others progress toward goals.
Motivates & supports others to gain skills
Does whatever it takes (within reason) to get the job done.
Regulatory/Compliance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Maintains a state of readiness to address new and changing regulations and procedures.
Performs audits regularly, or without notice, to ensure proper compliance with regulations.
Offers training to employees to ensure they comply with regulations.
Is aware of the documents and reports needed to maintain compliance with regulations.
Works quickly to implement changes in regulations.
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Creates the conditions for partnerships to grow and develop.
Seeks to reduce institutional roadblocks to information sharing.
Supports and encourages relationships that are created by diverse team members.
Maintains infrastructure to support partnerships and networks.
Capitalizes on partnerships and networks to enhance the Company's bottom line.
Strategic Insight	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Understands the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.
Identifies root causes of problems.
Identifies potential problems before they become critical incidents.
Analyzes unique issues or problems impacting the Company.
Implements long-term solutions to problems.

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: