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 ensure that all supervisors are aware of regulatory and compliance measures.
You are committed to safety in the workplace.
You perform work safely.
You develop a strong safety culture.
You seek to reduce the likelihood of accidents.
Bias for Action	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You complete work on time
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 complete a large volume of work.
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 do what was promised.
You maintain high standard of excellence when dealing with ethical, legal, or regulatory issues.
You foster an environment built upon trust.
You deliver on promises and meets obligations.
You are consistently open and honest with others.
Cultural Awareness	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You maintain an inclusive work environment that maximizes the talents of others in achieving goals.
You respect others regardless of age, race, gender, nationality, or disability.
You encourage a work environment where individual differences are valued.
You foster a diverse workforce free from discrimination and harassment.
You treat others with dignity and respect.
Administrative Skill	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are enthusiastic about taking on challenging projects.
You are able to develop, justify and present a budget.
You take responsibility for decisions.
You have a high attention to detail.
You complete reports on-time.
Problem Solving	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You implement effective solutions to critical problems.
You actively seek the root cause of a problem.
You evaluate alternative courses of action.
You are a good problem solver and decision maker
You analyze systems and processes for opportunities to gain efficiency.
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You take immediate action toward goals.
You encourage commitment in others to obtain results.
You coordinate all department activities into a cohesive team effort.
You create a sense of urgency among the store team members to complete activities, which drive sales.
You maintain persistence and dedication to achieving results.
Technical	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You seek information from others as needed.
You demonstrate mastery of the technical competencies required in your 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 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 are able to organize work.
You effectively organize resources and plans
You encourage others to take on greater responsibility.
You establish goals and objectives.
You organize and schedules events, activities, and resources.
Trustworthy	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You take care to maintain confidential information.
You are trustworthy; is someone that can be trusted.
You seek to mitigate grievances by clarifying intentions and finding suitable remedies.
You deliver on promises made.
You take ownership, deliver on commitments
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You maintain good interpersonal relationships with representatives from the other party.
You are flexible in responses.
You resolve difficult negotiations whether it is a contract, sub contract, legal or any other difficult negotiation fairly and reasonably.
You establish clear communications to avoid misunderstandings.
You are able to decline bad ideas to avoid making poor decisions.
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You understand and contribute to development of strategic goals.
You create plans to develop and promote organizational and area strengths, as well as to address weaknesses.
You focus attention on treating the causes of problems rather than simply addressing the symptoms.
You sustain or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
You look for opportunities to enhance contributions to the bottom line.

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.