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.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.

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
Identifies predictable hazards in the workplace.
Participates in safety training as applicable.
Supports safety programs and procedures.
Supports our company's safety programs.
Keeps accurate safety records.
Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works to eliminate unnecessary work or barriers that get in others' way.
Contributes to a positive work environment.
Treats all people fairly and with respect.
Is gracious and professional in their interactions with others.
Shows by their actions that they trust in the positive intentions of 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.
Stays focused even when under pressure and stress.
Helps guide employees with prioritizing tasks.
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
Acts with urgency when time is limited.
Is an inspiration for others to perform above expectations.
Initiates draft reports for consideration.
Gladly seeks additional responsibilities.
Initiates actions that impact the department/company.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Supports the Company's efforts to implement changes.
Supports new initiatives for organizational changes to improve effectiveness.
Adopts changes to set and example for others to follow.
Is an inspiration for others to accept the recent changes.
Inspires others to want to change.
Partnering/Networking	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Synchronizes efforts, processes, and resources with partners to enhance strategic opportunities.
Seeks to avoid conflicts by clarifying problems early on and working quickly to resolve those issues.
Maintains a network of partners and suppliers to facilitate global operations.
Partners with supply chain companies to enhance availability of resources and material.
Can perform a SWOT analyses (Strengths, Weaknesses, Opportunities, Threats) of the partnership's potential outcomes.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Makes decisions that yield more competitive advantages.
Creates measures of performance and profitability to assess financial objectives.
Creates values statement to ensure all employees are working under the same guiding principles.
Looks for opportunities to enhance contributions to the bottom line.
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.