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
Is not afraid to question a potential safety issue observed in the workplace.
Seeks to reduce the likelihood of accidents.
Creates accurate and effective measures of safety.
Encourages others to attend safety training.
Mitigates hazards and safety issues that arise.
Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Treats all people fairly and with respect.
Shows by their actions that they trust in the positive intentions of others.
Contributes to a positive work environment.
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.
Makes sure that employees understand and identify with the team's mission.
Stays focused even when under pressure and stress.
Excellent at managing time.
Functions well under stress, deadlines, and/or significant workloads.
Initiative	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Seeks and utilizes opportunities for continuous learning and self-development.
Prepares for unexpected contingencies.
Looks to start work on new projects without waiting for direction from the manager.
Initiates new projects for the department.
Addresses small problems before they become big ones.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Inspires others to accept changes.
Assists others in understanding changes to the organization.
Is an inspiration for others to accept the recent changes.
Supports new initiatives for organizational changes to improve effectiveness.
Adopts changes to set and example for others to follow.
Partnering/Networking	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports and encourages relationships that are created by diverse team members.
Forges mutually beneficial relationships between individuals with diverse backgrounds.
Seeks an understanding of diverse functions within the Company.
Creates the conditions for partnerships to grow and develop.
Maintains infrastructure to support partnerships and networks.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Focuses attention on treating the causes of problems rather than simply addressing the symptoms.
Sustains or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
Understands & contributes to development of strategic goals.
Able to decline a poor strategy by proposing alternate strategies.
Communicates goals and objectives to employees.

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.