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.

---

Safety	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Seeks to reduce the likelihood of accidents.
Participates in safety training when available.
Identifies predictable hazards in the workplace.
Develops safety guidelines for the department.
Participates in safety training when offered.
Time Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Does not procrastinate.
Keeps and maintains a To-Do list.
Prioritizes new tasks according to their relative importance.
Sets clearly defined goals.
Avoids distractions in the workplace.
Self Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Analyzes interpersonal problems instead of reacting to them.
Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
Steps away from a situation to process appropriate response.
Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
Uses patience and self-control in working with customers and associates.
Project Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Organizes work and sets priorities as needed.
Inspires others to accomplish goals and objectives.
Develops performance measures for various aspects of the project.
Develops action items, workplans, timelines, and criteria for projects.
Maintains costs and expenses within budget limits.
Conflict Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Helps employees to think through alternative ways to resolve conflict situations.
Assists team members by helping them see the other point of view.
Discusses conflict situations with supervisor.
Tries to understand others' point of view before making judgments
Deals effectively with employee grievances.
Decision Making	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Coaches team members individually when "poor" decisions are made; helps them see what could have been done differently
Seeks input from key people who should be involved in, or will be affected by, decisions
Is able to make decisions quickly.
Assesses the risks, benefits, and potential impact of a number of options when deciding a course of action
Breaks complex issues into manageable parts and organizes them in a systematic way before making decisions
Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Gets the job done.
Effectively makes decisions
Drives and mobilizes others progress toward goals.
Displays high energy and enthusiasm on consistent basis.
Motivates & supports others to gain skills
Regulatory/Compliance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Explains regulations and procedures to others as required.
Addresses issues quickly before they develop into major problems.
Follows all safety regulations and procedures.
Keeps informed of various regulations and procedures.
Reviews skill levels of employees in areas of policies and regulations to identify gaps where additional training is needed.
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Collaborates with others to accomplish goals and objectives.
Builds alliances between departments and teams.
Partners with peers to obtain influence within the Company.
Seeks to reduce institutional roadblocks to information sharing.
Develops a sense of trust in subordinates so they can freely interact and share information with others.
Strategic Insight	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Maintains knowledge of current trends in the industry.
Implements long-term solutions to problems.
Identifies root causes of problems.
Formulates strategies and action plans to ensure successful completion of goals and objectives.
Identifies potential problems before they become critical incidents.

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: