Safety - 360 Degree Feedback Survey Sample #6

360-Degree Assessment Survey

Dear Employee:

You have been selected to participate in a 360-assessment. As part of this process you will need to complete the self-assessment questionnaire below.

In responding to the questions below, think about your experiences over the last 12 months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question.

We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

The results of this survey will be used to help drive our future success. We will report back to you about what you have said and what we plan to do about it. If you have any questions about the process please contact [Contact Person].

Please ensure that your submission is made between . The survey will only be available during these dates.


Management Team

Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You keep accurate safety records.
You seek to reduce the likelihood of accidents.
You develop safety guidelines for the department.
You commit adequate resources toward safety measures.
You are not afraid to question a potential safety issue observed in the workplace.
Bias for Action	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You coach others to foster an environment which can adapt quickly and willingly to rapid change.
You encourage risk taking and experimentation to improve performance
You project a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
You identify ways to simplify work processes and reduce cycle times
You convey a sense of urgency about addressing problems and opportunities
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You maintain strong relationships with others.
You foster an environment built upon trust.
You do what was promised.
You do the right thing even when negative consequence may result.
You follow tasks to completion.
Cultural Awareness	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You respect others regardless of age, race, gender, nationality, or disability.
I am aware of cultural differences in business etiquette.
You avoid referring to stereotypes about others from different cultures.
You are sensitive to the similarities and differences that exist between cultures.
I seek to reduce obstacles in communication that might arise from cultural differences.
Administrative Skill	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are able to develop, justify and present a budget.
You have a high attention to detail.
You have strong technical/computer skills.
You are enthusiastic about taking on challenging projects.
You have strong organizational skills to keep the workspace and department in order
Problem Solving	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You make judgments based upon relevant information.
You actively seek the root cause of a problem.
You understand the root causes of problems.
You work cooperatively with others to solve problems.
You evaluate alternative courses of action.
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are willing to do whatever it takes-not afraid to have to put in extra effort.
You take immediate action toward goals.
You encourage commitment in others to obtain results.
You are committed to the team.
You coordinate all department activities into a cohesive team effort.
Technical	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You know how to produce high quality products/work.
You keep current with technical advances within your professional discipline; embrace and apply new techniques and practices
You are knowledgeable of procedures or systems necessary for the job.
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
You demonstrate mastery of the technical competencies required in your work.
Objectives	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You set long-term and short-term goals.
You work toward achieving established goals and objectives.
You are able to establish realistic goals.
You assure [Company] principles are understood, employed & pursued.
You communicate goals and objectives to employees.
Trustworthy	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You take ownership, deliver on commitments
You consistently keep commitments.
You take care to maintain confidential information.
You demonstrate a sense of responsibility and commitment to public trust.
You demonstrate congruence between statements and actions.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are able to say "no" when necessary to effectively execute business strategy and meet long-term objectives.
You conduct necessary preparations before engaging in negotiations.
You identify verbal and nonverbal cues to help interpret actions and messages.
You change communication styles to meet the listener's needs.
You are flexible in responses.
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I undertake a SWOT analysis to determine the best strategy to move forward.
You focus efforts on specific marketing strategies.
I give adequate consideration to the time and resources available.
You identify areas where return on investment can be improved.
You turn strategic priorities into action plans.

61. Overall, please rate the effectiveness of [Participant Name Here].
    

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
62. Describe the greatest strengths of this person with regard to his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
63. Describe the most important things this person could improve upon in order to increase his/her overall effectiveness in performing his/her current responsibilities.
    
    
    
64. Additional comments, if any for [Participant Name Here]'s assessment.