Safety - 360 Degree Feedback Survey Sample #7

360 Feedback Survey

Instructions

is administering a new web-based survey tool which is designed to gather broad feedback as it relates to core competencies and role responsibilities that are important for the on-going success of our organization. The Leadership Team Members have agreed to participate and are seeking your feedback.

In this regard, you have been selected to provide feedback for the manager listed above. Your feedback is an important part of 's leadership development process. This tool 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 assessment form, please think about your experiences working with this individual during the last twelve (12) months. Your responses will be merged with other people's feedback and presented to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager, unless you indicate otherwise.

You are only being asked to rate 8 competencies. Each competency will have a variety of statements that are grouped by 4 Performance Levels. Click on the level that best describes this individual.

Please ensure that your submission is made between .

Safety	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Performs work safely.
Participates in safety training when available.
Is aware of OSHA safety guidelines.
Develops a strong safety culture.
Identifies predictable hazards in the workplace.
If [Participant Name] were to make improvements in Safety, what are your suggestions for how he/she can improve this?
Communication Skills	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Able to deliver presentations.
Delivers information in a clear, concise, and logical manner.
Deals with difficult situations calmly and confidently.
Checks for understanding throughout conversations or group presentations/discussions
Communicates effectively with all levels of the organization.
If [Participant Name] were to make improvements in Communication Skills, what are your suggestions for how he/she can improve this?
Creativity	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Creates a lot of new ideas.
Adds value to the department/organization.
Inspires creativity in their team.
Is creative.
Develops solutions to challenging problems.
If [Participant Name] were to make improvements in Creativity, what are your suggestions for how he/she can improve this?
Professional Development	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Contributing fully to the extent of their skills
Seeks opportunities for professional development.
Keep themselves up-to-date of technical/professional issues
Quickly acquire and apply new knowledge and skills when needed
Seeks opportunities for continuous learning.
If [Participant Name] were to make improvements in Professional Development, what are your suggestions for how he/she can improve this?
Feedback	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Is easy to approach with ideas and opinions.
Open to the suggestions of others.
Actively seeks feedback from others.
Shares past experiences with others as learning opportunities.
Looks to others for input.
If [Participant Name] were to make improvements in Feedback, what are your suggestions for how he/she can improve this?
Achievement	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Systematically works to improve the organization
Takes calculated risks to achieve higher levels of performance.
Takes immediate action of projects that fall behind schedule.
Reduces staff turnover.
Successfully completed the orientation training program.
If [Participant Name] were to make improvements in Achievement, what are your suggestions for how he/she can improve this?
Planning	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Anticipates challenges and has plans to overcome them.
Understands what materials will be required to successfully implement the plan.
Able to look ahead (beyond the present) when addressing the work/needs of the department.
Creates effective logistics plans to achieve high operational efficiency.
Creates a timeline for events and monitors progress.
If [Participant Name] were to make improvements in Planning, what are your suggestions for how he/she can improve this?

36. Strengths
    
    
    
37. Areas for Development
    
    
    
38. Please give any final comments or suggestions for [Participant Name Here]'s assessment.