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

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Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are committed to safety in the workplace.
You participate in safety training as applicable.
You develop a strong safety culture.
You encourage others to attend safety training.
You develop safety guidelines for the department.
Bias for Action	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You seek and utilize opportunities for continuous learning and self-development.
You motivate others to achieve or exceed goals
You convey a sense of urgency about addressing problems and opportunities
You encourage risk taking and experimentation to improve performance
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 demonstrate a commitment to corporate and personal values.
You deliver on promises and meets obligations.
You demonstrate honesty and truthfulness at all times.
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
You are curious and willing to ask questions about the cultural differences in the workplace.
I am an advocate for others with different cultural backgrounds.
You recognize and value individual and cultural differences.
You are aware of the similarities and differences among and between cultural groups.
I develop skills and attitudes to bridge cultural differences.
Administrative Skill	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You accurately implement contract provisions.
You have a high attention to detail.
You complete reports on-time.
You are enthusiastic about taking on challenging projects.
You are able to develop, justify and present a budget.
Problem Solving	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I am able to conduct a thorough Critical Incident interview.
I continuously monitor performance after implementing a solution to ensure it remains effective.
You make judgments based upon relevant information.
You are able to solve problems at root cause rather than at symptom level.
You determine the order in which the action steps need to be completed including steps that may be dependent on others.
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 create a sense of urgency among the store team members to complete activities, which drive sales.
You encourage commitment in others to obtain results.
You are committed to the team.
You convey strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
Technical	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You willingly share information and expertise; sought out as resource by others
You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
You are knowledgeable of procedures or systems necessary for the job.
You demonstrate mastery of the technical competencies required in your work.
You willingly share your technical expertise; sought out as resource by others
Objectives	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You work toward achieving established goals and objectives.
You encourage others to take on greater responsibility.
You consistently provide me with timely feedback for improving my performance.
You effectively organize resources and plans
You establish goals and objectives.
Trustworthy	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You deliver on promises made.
You are a person others can count on.
You take care to maintain confidential information.
You seek to mitigate grievances by clarifying intentions and finding suitable remedies.
You demonstrate a sense of responsibility and commitment to public trust.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You maintain control over emotions to ensure a constructive environment.
You take steps to control emotional responses to avoid making rash decisions.
I am an effective negotiator, fostering positive relationships and achieving good outcomes.
You are able to control your emotional responses and correctly gauge the emotions of others.
You actively listen to conversations to be able to recall important details later.
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
I create a vision for the organization based on how the organization should appear in the future.
You support changes being recommended from senior management.
You assign individuals the responsibility of keeping track of progress toward achieving milestones.
I monitor company performance and make adjustments to the strategic plan as needed.
You are able to identify internal strengths and weaknesses and the opportunities and threats that impact the company.

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.