Safety - 360 Degree Feedback Survey Sample #6

Dear Employee:

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve 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. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going development.

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 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 and . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team

Safety	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Creates accurate and effective measures of safety.
Commits adequate resources toward safety measures.
Develops a sustainable safety culture.
Keeps accurate safety records.
Seeks to reduce the likelihood of accidents.
Bias for Action	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Completes a large volume of work.
Seeks and utilizes opportunities for continuous learning and self-development.
Coach others to foster an environment which can adapt quickly and willingly to rapid change.
Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
Motivates others to achieve or exceed goals
Integrity	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Develops trust and confidence from others.
Accepts responsibility for mistakes.
Demonstrates sincerity in actions with others.
Demonstrates honesty and truthfulness at all times.
Maintains strong relationships with others.
Cultural Awareness	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Maintains an inclusive work environment that maximizes the talents of others in achieving goals.
Encourages a work environment where individual differences are valued.
Respects others regardless of age, race, gender, nationality, or disability.
Shows respect in daily interactions
Fosters a diverse workforce free from discrimination and harassment.
Administrative Skill	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Has strong technical/computer skills.
Able to develop, justify and present a budget.
High attention to detail.
Implements and uses performance measures.
Strong organizational skills to keep the workspace and department in order
Problem Solving	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Effective in solving problems.
Identifies and assesses all potential responses to a problem.
Ability to solve problems at root cause rather than at symptom level.
Is a good problem solver and decision maker
Ability to develop innovative solutions to problems.
Commitment To Result	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Creates a sense of urgency among the store team members to complete activities, which drive sales.
Encourages commitment in others to obtain results.
Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.
Willing to do whatever it takes-not afraid to have to put in extra effort.
Takes immediate action toward goals.
Technical	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Willingly shares information and expertise; sought out as resource by others
Is knowledgeable of procedures or systems necessary for the job.
Willingly shares his/her technical expertise; sought out as resource by others
Uses expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
Demonstrates mastery of the technical competencies required in his/her work.
Objectives	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Effectively organizes resources and plans
Able to organize work.
Establishes goals and objectives.
Works toward achieving established goals and objectives.
Ability to establish realistic goals.
Trustworthy	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Is trustworthy; is someone I can trust.
Seeks to mitigate grievances by clarifying intentions and finding suitable remedies.
Consistently keeps commitments.
Takes ownership, delivers on commitments
Demonstrates a sense of responsibility and commitment to public trust.
Negotiation	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Able to say "no" when it is essential to maintaining quality and high standards.
Influences others through rational argument and persuasion.
Is able to decline bad ideas to avoid making poor decisions.
Leverages relationships with others to achieve goals.
Able to say "no" when necessary to effectively execute business strategy and meet long-term objectives.
Strategic Focus	Needs Significant Improvement	Could benefit from Development	Capable and Effective	Role Model
Understands their role within the organization.
Looks for opportunities to enhance contributions to the bottom line.
Able to decline a poor strategy by proposing alternate strategies.
Monitors performance of each market within the Area, utilizing reports to ensure sales growth, cost management, and profitability targets are met.
Sustains or achieves a competitive advantage for the organization by analyzing the best practices and lessons learned from other organizations.

61. Overall, please rate the effectiveness of .
    

    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 's assessment.