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
Seeks to reduce the likelihood of accidents.
Is aware of OSHA safety guidelines.
Encourages others to attend safety training.
Is not afraid to question a potential safety issue observed in the workplace.
Participates in safety training when available.
Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Shows by their actions that they trust in the positive intentions of others.
Contributes to a positive work environment.
Contributes to a positive and fun work environment.
Works to eliminate unnecessary work or barriers that get in others' way.
Is gracious and professional in their interactions with others.
Establishing Focus/Direction	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Sets appropriate goals for employees.
Maintains focus when handling several problems or tasks simultaneously.
Functions well under stress, deadlines, and/or significant workloads.
Aligns the department's goals with the goals of the organization.
Excellent at managing time.
Initiative	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Immediately works to complete goals well before their deadline.
Takes decisive action to address problems, following up with relevant team members and coaching them on how to improve.
Coach others to foster an environment which can adapt quickly and willingly to rapid change.
Takes action without being asked.
Goes above and beyond the stated goals.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports the Company's efforts to implement changes.
Effective in implementing new organizational vision and values.
Supports new initiatives for organizational changes to improve effectiveness.
Assists others in understanding changes to the organization.
Adopts changes to set and example for others to follow.
Partnering/Networking	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Promotes the understanding of how the department affects the organization overall.
Creates value within the Company by building networks.
Partners with peers to obtain influence within the Company.
Capitalizes on partnerships and networks to enhance the Company's bottom line.
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
Able to decline a poor strategy by proposing alternate strategies.
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.
Looks for opportunities to enhance contributions to the bottom line.
Focuses attention on treating the causes of problems rather than simply addressing the symptoms.

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.