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
Performs work safely.
Commits adequate resources toward safety measures.
Is not afraid to question a potential safety issue observed in the workplace.
Encourages others to work safely.
Points out behaviors in others that may be unsafe.
Time Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Makes time for developing plans and schedules.
Gets more accomplished than others in the same amount of time.
Is committed to finishing the most important tasks.
Adheres to project timelines.
Confronts significant problems directly to reduce their impact on the schedule.
Self Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
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.
Uses patience and self-control in working with customers and associates.
Does not allow own emotions to interfere with the performance of others.
Analyzes interpersonal problems instead of reacting to them.
Project Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Has detailed knowledge about the project and can adapt the project plan as needed.
Uses appropriate technology to efficiently communicate with team members.
Ensures the project is executed on time and on budget.
Effective at using video conferencing software to manage remote teams.
Adds the necessary time buffers to avoid the project getting behind schedule.
Conflict Management	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Works with others as needed to facilitate resolution of conflicts.
Is supportive of consensus and power sharing.
Attempts to determine the root sources of grievances.
Establishes roles and responsibilities of team members.
Helps employees to think through alternative ways to resolve conflict situations.
Decision Making	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Examines relevant factors needed to make a decision.
Understands how their decisions will affect others.
Is able to make decisions quickly.
Makes decisions independently (without having to be told what or how).
Examines for patterns in data to help predict future possibilities.
Action	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Takes action to respond to dissatisfied customer.
Is not afraid to take corrective action when necessary.
Regularly conducts preventative maintenance on the equipment.
Avoids "Analysis Paralysis" through action.
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
Develops strategies to comply with established regulations.
Provides documents and reports as needed to maintain compliance with laws.
Addresses issues quickly before they develop into major problems.
Creates an oversight panel to provide comprehensive supervision for the organization.
Appoints a supervisory committee to ensure effective oversight of the organization.
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Creates value within the Company by building networks.
Builds trust with colleagues at other companies to form partnerships to promote growth.
Develops key business contacts at other companies.
Facilitates cross-functional collaboration and information sharing between various stakeholders.
Collaborates with others to accomplish goals and objectives.
Strategic Insight	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Analyzes records and reports to obtain insight into potential issues and trends.
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.
Ensures that the department's goals are strategically aligned with the company's goals.
Develops a strategic vision for the future.

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: