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
Is aware of OSHA safety guidelines.
Commits adequate resources toward safety measures.
Develops a sustainable safety culture.
Develops a strong safety culture.
Creates accurate and effective measures of safety.
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
Delivers well-prepared, informed, poised and succinct presentations.
Able to deliver presentations.
Chooses the communication medium (ie. email, voice mail, memo, project document) that reflects the needs of the content. (ie. urgency, confidentiality, content scope)
Has the confidence to communicate effectively to all levels (from CEO down) of the organization, external customers, suppliers, as well as the senior counsel of other companies.
Conveys ideas confidently and succinctly.
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
Is creative and inspirational.
Adds value to the department/organization.
Creates a lot of new ideas.
Conceives, implements and evaluates ideas.
Is creative.
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 continuous learning.
Encourages employees to take courses relevant to their job.
Demonstrate enthusiasm and a willingness to learn new skills and knowledge
Quickly acquire and apply new knowledge and skills when needed
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 visible and approachable.
Actively seeks feedback from others.
Shares past experiences with others as learning opportunities.
Open to the suggestions of others.
Is easy to approach with ideas and opinions.
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
Demonstrates improvement in performance.
Makes a plan for getting things done and drives execution of the strategic plan, actively supporting or leading initiatives to closure.
Sets challenging goals.
Establishes stretch goals to advance skills and output.
Strives to exceed standards of performance.
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
Makes plans and follows through.
Able to look ahead (beyond the present) when addressing the work/needs of the department.
Able to identify the needs of the department before a major change.
Anticipates potential challenges, develops plan to overcome them and then carries out the plan.
Works in an organized manner
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.