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
Mitigates hazards and safety issues that arise.
Develops a culture of safety.
Encourages others to attend safety training.
Encourages others to work safely.
Keeps accurate safety records.
Time Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Maintains precise time logs for billing.
Remains dedicated to completing high priority work.
Adheres to project timelines.
Is prompt and diligent in their work.
Performs high-impact work first.
Self Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Deals with conflict by controlling own emotions by listening, being flexible, and sincere in responding.
Steps away from a situation to process appropriate response.
Analyzes own reactions on the spot to ensure that communication does not appear to be driven by anger.
Sets an example for associates during stressful periods by maintaining a positive, can-do attitude.
Consciously controls own negative emotions in order to keep team morale up.
Project Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Understands the budget constraints for the project.
Hold team members accountable for completing specific tasks on the project.
Assesses the ability of the organization to handle the project.
Identifies the source materials that will be needed.
Communicates with all employees involved on the project.
Conflict Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Avoids being judgmental and micromanaging of employees.
Works to meet the basic needs of each side in the conflict.
Seeks to remove misperceptions that may contribute toward conflict.
Seeks to avert the recurrence of conflict issues.
Listens to individuals as they offer their unique perspectives on the situation.
Decision Making	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Understands how their decisions will affect others.
Considers the ethical implications of decisions.
Examines relevant factors needed to make a decision.
Remains focused on the immediate goal when making decisions.
Maintains focus on the "big picture" when making decisions.
Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Initiates actions to get things done.
Establishes the tasks and direction for the team.
Changes course to meet the needs of a new situation.
Takes action in critical situations.
Takes steps to prepare for the start of the project.
Regulatory/Compliance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Offers training to employees to ensure they comply with regulations.
Maintains historical records and documents as needed/required.
Understands the applicable regulations and laws that impact our business.
Ensures the company is in compliance with industry specifications, standards, and applicable laws.
Ensures the company is in compliance with all laws regarding the production and transportation of product.
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Successfully identifies complementary and compatible strategic partners with colleagues in the industry.
Exchanges ideas, resources, plans, and technologies with colleagues.
Able to highlight both the strategic benefits and potential pitfalls in collaboration.
Hosts forums, colloquiums, and seminars to share information and ideas.
Searches for a common solution to shared problems or issues.
Strategic Insight	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Implements long-term solutions to problems.
Pursues strategic alliances with valued partners.
Observes employees at work to get better insight into the issues they are dealing with.
Creates values statement to ensure all employees are working under the same guiding principles.
Recognizes the needs of customers.

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: