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
Ensures that all supervisors are aware of regulatory and compliance measures.
Supports safety programs and procedures.
Identifies and addresses safety needs.
Supports our company's safety programs.
Encourages others to attend safety training.
Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Visibly supports and encourages diversity in style and background.
Contributes to a positive work environment.
Works to eliminate unnecessary work or barriers that get in others' way.
Treats all people fairly and with respect.
Is gracious and professional in their interactions with others.
Establishing Focus/Direction	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Makes sure that employees understand how their work relates to organizational goals.
Maintains focus when handling several problems or tasks simultaneously.
Maintains self-control when personally criticized.
Functions well under stress, deadlines, and/or significant workloads.
Sets appropriate goals for employees.
Initiative	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Looks to start work on new projects without waiting for direction from the manager.
Acts with urgency when time is of the essence.
Gladly seeks additional responsibilities.
Volunteers time and effort toward the completion of important goals.
Takes action to implement new changes in the policies and procedures.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Effective in dealing with ambiguous and challenging situations.
Inspires others to accept changes.
Develops plans for following through on the changes.
Is a leading force driving changes.
Facilitates change with minimal resistance.
Partnering/Networking	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Builds alliances between departments and teams.
Creates value within the Company by building networks.
Maintains infrastructure to support partnerships and networks.
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 Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Makes sure that all departments/teams are contributing toward the success of the strategy.
Supports changes being recommended from senior management.
Creates a SWOT matrix to help analyze data.
Coordinates the implementation of the strategy with stakeholders.
Maintains strategic focus by regularly reviewing the strategic plan and taking corrective actions as needed to stay on track.

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.