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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Thank you for your participation in the survey.

Management Team

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Safety	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Works to implement corrective safety measures.
Commits adequate resources toward safety measures.
Participates in safety training as applicable.
Seeks to reduce the likelihood of accidents.
Develops safety guidelines for the department.
Attitude	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Builds open and trusting relationships.
Shows by their actions that they trust in the positive intentions of others.
Treats all people fairly and with respect.
Contributes to a positive work environment.
Contributes to a positive and fun work environment.
Establishing Focus/Direction	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Maintains self-control when personally criticized.
Makes sure that employees understand and identify with the team's mission.
Makes sure that employees understand how their work relates to organizational goals.
Sets appropriate goals for employees.
Aligns the department's goals with the goals of the organization.
Initiative	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Takes the initiative to complete tasks ahead of schedule.
Encourages others on the team to suggest process improvements.
Initiates important conversation topics at meetings.
Capitalizes on opportunities as they become available.
Addresses small problems before they become big ones.
Change Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is an inspiration for others to accept the recent changes.
Develops a strategy for implementing changes.
Able to get department employees to accept new changes.
Able to get team members to change their attitudes.
Works cooperatively with others to implement changes.
Partnering/Networking	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Is comfortable working in partnership with colleagues from other departments.
Develops networks with other companies to reduce costs and improve services.
Attends industry conferences and seminars to meet new contacts and learn from industry leaders.
Develops networks and builds alliances.
Shares resources, technology, facilities, or intellectual property to benefit both partners.
Strategic Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
Creates values statement to ensure all employees are working under the same guiding principles.
Creates deadlines for various components of the strategy.
Identifies and focuses resources on strategic growth opportunities.
Supports changes being recommended from senior management.
Evaluates and reviews the implementation of the strategic plan to ensure achievement of the objectives.

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.