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 are aware of osha safety guidelines.
You support safety programs and procedures.
You commit adequate resources toward safety measures.
You participate in safety training when available.
You develop a culture of safety.
Bias for Action	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You complete work on time
You complete a large volume of work.
You coach others to foster an environment which can adapt quickly and willingly to rapid change.
You seek and utilize opportunities for continuous learning and self-development.
You identify ways to simplify work processes and reduce cycle times
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You do not withhold important information needed by others.
You maintain strong relationships with others.
You demonstrate honesty and truthfulness at all times.
You accept responsibility for mistakes.
You protect the integrity and confidentiality of information
Cultural Awareness	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You encourage a work environment where individual differences are valued.
I value the diverse perspectives from others.
I am responsive to individuals from other cultures.
You are open and honest in communications with individuals from other cultures.
You support and mentor others that may have different cultural backgrounds.
Administrative Skill	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You have strong organizational skills to keep the workspace and department in order
You take responsibility for decisions.
You implement and use performance measures.
You are able to develop, justify and present a budget.
You have a high attention to detail.
Problem Solving	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You evaluate alternative courses of action.
You are able to balance the needs of different people in a solution to a problem.
You are able to solve problems at root cause rather than at symptom level.
You can develop innovative solutions to problems.
You generate alternative solutions to problems and challenges.
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You take immediate action toward goals.
You coordinate all department activities into a cohesive team effort.
You convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
You are committed to the team.
You are willing to do whatever it takes-not afraid to have to put in extra effort.
Technical	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You know how to produce high quality products/work.
You willingly share your technical expertise; sought out as resource by others
You demonstrate mastery of the technical competencies required in your work.
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
You are naturally sought out by people outside your particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.
Objectives	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You organize and schedules events, activities, and resources.
You work toward achieving established goals and objectives.
You consistently provide me with timely feedback for improving my performance.
You establish goals and objectives.
You communicate goals and objectives to employees.
Trustworthy	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You take care to maintain confidential information.
You communicate an understanding of the other person's interests, needs and concerns.
You consistently keep commitments.
You work in a way that makes others want to work with you.
You take ownership, deliver on commitments
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I listen to all sides without bias and make fair decisions.
I establish a positive connection with the other party to create a more collaborative atmosphere, making it easier to reach mutually beneficial agreements.
You justify viewpoints using strong and credible data.
You are able to control your emotional responses and correctly gauge the emotions of others.
I establish a strong, cooperative atmosphere; defines expectations; and presents a well-structured agenda aligned with key priorities.
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You sustain or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
I create measures of performance and profitability to assess financial objectives.
You monitor performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
I undertake a SWOT analysis to determine the best strategy to move forward.
I detect changes in the environment and updates the strategic plan to address new opportunities or threats.

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.