Safety - 360 Degree Feedback Survey Sample #7

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 and .

Safety	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Develops a culture of safety.
Encourages others to attend safety training.
Is not afraid to question a potential safety issue observed in the workplace.
Performs work safely.
Committed to safety in the workplace.
If 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
Coaches others and provides feedback on the use of different oral communication styles for different audiences
Deals with difficult situations calmly and confidently.
Is an effective communicator
An effective listener who is responsive to information needs.
Asks follow-up questions as needed.
If 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.
Inspires creativity in their team.
Develops solutions to challenging problems.
Is creative.
Adds value to the department/organization.
If 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
Seeks opportunities for continuous learning.
Seeks opportunities for professional development.
Quickly acquire and apply new knowledge and skills when needed
Demonstrate enthusiasm and a willingness to learn new skills and knowledge
Encourages employees to take courses relevant to their job.
If 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
Seeks feedback to enhance performance.
Is visible and approachable.
Asks others for their ideas and opinions.
Is easy to approach with ideas and opinions.
Accepts the views of others.
If 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
Accepts setbacks and challenges as improvement opportunities
Follows-up and takes action when goals are not met to ensure better results in the future.
Schedules time for self and others to optimize high priority and long term actions. Monitors progress towards business goals.
Completes work to given time frame and to budget
Demonstrates a well-organized and timely approach to achieve desired results
If 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 potential challenges, develops plan to overcome them and then carries out the plan.
Able to identify the needs of the department before a major change.
Delegates role to team members to accomplish goals.
Able to look ahead (beyond the present) when addressing the work/needs of the department.
Anticipates obstacles and ways to overcome them.
If 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 's assessment.