Safety - 360 Degree Feedback Survey Sample #7

360 Feedback Survey

Instructions

We are requesting your participation in a 360-degree feedback review of several participants in our company's Leadership Development program. We are 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 this manager'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.

You will get the chance to evaluate this manager's performance in different areas and share your thoughts through written comments for more detailed feedback. Ensure that your feedback is constructive and helpful.

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 .

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Safety	Needs Improvement		Fully Proficient		Excels/ Role Model	Not Applicable
Commits adequate resources toward safety measures.
Develops a culture of safety.
Is aware of OSHA safety guidelines.
Creates accurate and effective measures of safety.
Participates in safety training as applicable.
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 messages with personal energy, enthusiasm, and conviction.
Provides feedback in a helpful and respectful way, focusing on improvement.
Clarifies problems logically, simplifying complex matters into digestible parts.
Makes the complex simple.
Communicates with department leadership
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
Develops solutions to challenging problems.
Adds value to the department/organization.
Inspires creativity in their team.
Creates a lot of new 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
Seeks opportunities for professional development.
Seeks opportunities for continuous learning.
Allows employees to fully participate in employee training and professional development.
Demonstrate enthusiasm and a willingness to learn new skills and knowledge
Keep themselves up-to-date of technical/professional issues
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
Considers other's opinion and suggestions.
Shares past experiences with others as learning opportunities.
Open to the suggestions of others.
Looks to others for input.
Accepts the views of others.
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
Follows-up and takes action when goals are not met to ensure better results in the future.
Successfully launched the ABC project.
Driven to complete assignments on time.
Uses established goals and performance measures to keep track of performance.
Accepts setbacks and challenges as improvement opportunities
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
Creates to-do lists to make sure nothing is missed.
Allows input from others for the 5-year plan.
Develops strategic plans for ensuring competitiveness in the marketplace.
Understands the process for developing strategic plans for the organization.
Determines the appropriate actions needed to achieve goals.
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.