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 safety guidelines for the department.
You identify predictable hazards in the workplace.
You are aware of osha safety guidelines.
You participate in safety training when offered.
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 identify ways to simplify work processes and reduce cycle times
You coach others to foster an environment which can adapt quickly and willingly to rapid change.
You project a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
You seek and utilize opportunities for continuous learning and self-development.
You display high energy and enthusiasm on consistent basis.
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You accept responsibility for mistakes.
You demonstrate honesty and truthfulness at all times.
You always conduct yourself in an honest and upfront manner
You foster a high standard of ethics and integrity.
You do the right thing even when negative consequence may result.
Cultural Awareness	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You value the opinions of diverse groups and individual.
You hire individuals with different cultural backgrounds for the department.
You support and mentor others that may have different cultural backgrounds.
I interact effectively with people from different cultural backgrounds.
I function effectively within various cultural contexts.
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 implement and use performance measures.
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
You make judgments based upon relevant information.
You are effective in solving problems.
You work cooperatively with others to solve problems.
You solve problems using logic and insight.
You are a good problem solver and decision maker
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You are committed to the team.
You take immediate action toward goals.
You maintain persistence and dedication to achieving results.
You are able to focus on a task even when working alone.
You coordinate all department activities into a cohesive team effort.
Technical	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
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.
You seek information from others as needed.
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.
Objectives	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You consistently provide me with timely feedback for improving my performance.
You establish goals and objectives.
You are able to organize work.
You set long-term and short-term goals.
You assure [Company] principles are understood, employed & pursued.
Trustworthy	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You work in a way that makes others want to work with you.
You demonstrate a sense of responsibility and commitment to public trust.
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 establish good working relationships with others.
You are able to influence others to accept certain positions.
You are able to clearly express thoughts and concerns.
You resolve difficult negotiations whether it is a contract, sub contract, legal or any other difficult negotiation fairly and reasonably.
You conduct necessary preparations before engaging in negotiations.
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
You look for opportunities to enhance contributions to the bottom line.
You sustain or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.
You understand your role within the organization.
You focus attention on treating the causes of problems rather than simply addressing the symptoms.
You understand and contribute to development of strategic goals.

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.