Safety - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

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 when available.
Supports safety programs and procedures.
Seeks to reduce the likelihood of accidents.
Identifies and addresses safety needs.
Works to implement corrective safety measures.
Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Visibly supports and encourages diversity in style and background.
Treats all people fairly and with respect.
Works to eliminate unnecessary work or barriers that get in others' way.
Is gracious and professional in their interactions with others.
Builds open and trusting relationships.
Establishing Focus/Direction	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Maintains focus when handling several problems or tasks simultaneously.
Functions well under stress, deadlines, and/or significant workloads.
Stays focused even when under pressure and stress.
Makes sure that employees understand how their work relates to organizational goals.
Makes sure that employees understand and identify with the team's mission.
Initiative	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Analyzes the needs of the situation and acts before being told to do so.
Takes action without being asked.
Will continue to work on a problem even in the face of obstacles.
Prepares for unexpected contingencies.
Immediately informs the supervisor of any critical incidents.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Able to get team members to change their attitudes.
Addresses organizational and departmental resistance to changes.
Inspires others to want to change.
Effective in dealing with ambiguous and challenging situations.
Develops a strategy for implementing changes.
Partnering/Networking	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Hosts forums, colloquiums, and seminars to share information and ideas.
Inspires employees to seek out new collaboration opportunities to broaden market reach.
Networks with others in the company to better understand the workflows and operational requirements.
Establishes collaborative business relationships to unlock and enhance growth opportunities.
Optimizes processes by leveraging each function's strength.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Communicates goals and objectives to employees.
Supports changes being recommended from senior management.
Identifies bottlenecks in the production process and develops strategies to correct these issues.
Makes strategic decisions that take into account a dynamic situation.
Understands the importance of developing strategic capabilities.

36. Overall, please rate the effectiveness of [Participant Name Here].
    

    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 [Participant Name Here]'s assessment.