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 develop a strong safety culture.
You identify and addresses safety needs.
You perform work safely.
You support our company's safety programs.
You point out behaviors in others that may be unsafe.
Bias for Action	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You project a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
You motivate others to achieve or exceed goals
You encourage risk taking and experimentation to improve performance
You seek and utilize opportunities for continuous learning and self-development.
You coach others to foster an environment which can adapt quickly and willingly to rapid change.
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You follow tasks to completion.
You accept responsibility for mistakes.
You do not withhold important information needed by others.
You protect the integrity and confidentiality of information
You always conduct yourself in an honest and upfront manner
Cultural Awareness	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I am aware of my cultural views.
You avoid referring to stereotypes about others from different cultures.
You engage with individuals that have different cultural backgrounds.
I value the diverse perspectives from others.
I seek clarification to avoid misunderstandings.
Administrative Skill	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You have strong technical/computer skills.
You accurately implement contract provisions.
You implement and use performance measures.
You take responsibility for decisions.
You are able to develop, justify and present a budget.
Problem Solving	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You generate alternative solutions to problems and challenges.
You evaluate alternative courses of action.
I am skilled at quickly diagnosing issues, identifying root causes, and developing and implementing effective solutions in the workplace.
You make judgments based upon relevant information.
You are able to solve problems at root cause rather than at symptom level.
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You maintain persistence and dedication to achieving results.
You create a sense of urgency among the store team members to complete activities, which drive sales.
You are willing to do whatever it takes-not afraid to have to put in extra effort.
You coordinate all department activities into a cohesive team effort.
You take immediate action toward goals.
Technical	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
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.
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 seek information from others as needed.
Objectives	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You work toward achieving established goals and objectives.
You effectively organize resources and plans
You assure [Company] principles are understood, employed & pursued.
You set long-term and short-term goals.
You are able to organize work.
Trustworthy	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You consistently keep commitments.
You are trustworthy; is someone that can be trusted.
You communicate an understanding of the other person's interests, needs and concerns.
You demonstrate a sense of responsibility and commitment to public trust.
You take ownership, deliver on commitments
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You collect information from various stakeholders, each with their own viewpoints, data, and interests.
I can tailor my approache to more effectively address current demands.
I always have a "game plan" prior to entering into negotiations.
You understand the expectations of other parties in the negotiation.
You are able to say "no" when it is essential to maintaining quality and high standards.
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I develop high-level strategic planning models to identify opportunities to improve the company.
You let employees know how their roles contribute toward the achievement of strategic company objectives.
You create a strategy to pursue and maintain a competitive advantage in business.
I identify strengths that competitors would have trouble imitating.
You develop a corporate strategy to establish business operations in different locations.

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.