Safety - 360 Degree Feedback Survey Sample #5

Dear Employee:

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the Closing Comments section. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

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Please ensure that your submission is made by .

Thank you for your participation in the survey.

Management Team

Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Participates in safety training as applicable.
Identifies and addresses safety needs.
Creates accurate and effective measures of safety.
Participates in safety training when available.
Identifies predictable hazards in the workplace.
Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Visibly supports and encourages diversity in style and background.
Contributes to a positive and fun work environment.
Shows by their actions that they trust in the positive intentions of others.
Builds open and trusting relationships.
Works to eliminate unnecessary work or barriers that get in others' way.
Establishing Focus/Direction	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Makes sure that employees understand how their work relates to organizational goals.
Helps guide employees with prioritizing tasks.
Maintains focus when handling several problems or tasks simultaneously.
Excellent at managing time.
Aligns the department's goals with the goals of the organization.
Initiative	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Coach others to foster an environment which can adapt quickly and willingly to rapid change.
Goes above and beyond the stated goals.
Prepares for unexpected contingencies.
Immediately works to complete goals well before their deadline.
Seeks and utilizes opportunities for continuous learning and self-development.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Adopts changes to set and example for others to follow.
Effective in dealing with ambiguous and challenging situations.
Supports the Company's efforts to implement changes.
Supports new initiatives for organizational changes to improve effectiveness.
Effective in implementing new organizational vision and values.
Partnering/Networking	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports and encourages relationships that are created by diverse team members.
Promotes the understanding of how the department affects the organization overall.
Creates value within the Company by building networks.
Seeks an understanding of diverse functions within the Company.
Forges mutually beneficial relationships between individuals with diverse backgrounds.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Understands their role within the organization.
Monitors performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
Focuses attention on treating the causes of problems rather than simply addressing the symptoms.
Looks for opportunities to enhance contributions to the bottom line.
Creates plans to develop and promote organizational and area strengths, as well as to address weaknesses.

36. Overall, please rate the effectiveness of .
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
37. Strengths
    
    
    
38. Areas for Development
    
    
    
39. Please give any final comments or suggestions for 's assessment.