Safety - 360 Degree Feedback Survey Sample #8

Questionnaires Measuring Safety:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)

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 six to twelve months. Your responses will be merged with other people's feedback and presented to to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager.

Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.

When clicking your selection below, try to best fit the manager's actual behaviors to the scale provided.

If you are not sure, or unable to assess, select "Not Applicable" (N/A) option.

Please complete your response by .


Agree Unsure Disagree N/A
  1. Develops a strong safety culture.
  1. Keeps accurate safety records.
  1. Committed to safety in the workplace.
  1. Works to implement corrective safety measures.
  1. Develops a culture of safety.

Continual Learning

Agree Unsure Disagree N/A
  1. Shares best practices with others and learns from others.
  1. Grasps new ideas, concepts, technical, or business knowledge.
  1. Pursues self-improvement through continual learning.
  1. Builds on their strengths while addressing their weaknesses.
  1. Sets relevant learning objectives and goals.

Professional Development

Agree Unsure Disagree N/A
  1. Quickly acquire and apply new knowledge and skills when needed
  1. Allows employees to fully participate in employee training and professional development.
  1. Seeks opportunities for continuous learning.
  1. Contributing fully to the extent of their skills
  1. Encourages employees to take courses relevant to their job.

Emotional Intelligence

Agree Unsure Disagree N/A
  1. Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.
  1. Is able to manage their own emotions.
  1. Able to understand others' points of view.
  1. Is able to control their own emotions.
  1. Helps to make decisions and solve problems using knowledge about how others will react in certain situations.


Agree Unsure Disagree N/A
  1. Achieves established goals.
  1. Achieves goals.
  1. Sets high expectations and goals; encourages others to support the organization.
  1. Conducts timely follow-up; keeps others informed on a need to know basis.
  1. Understands & contributes to development of strategic goals.

Results Oriented

Agree Unsure Disagree N/A
  1. Does not become distracted by non-issues or interruptions.
  1. Demonstrates the personal confidence to "stay the course," even when faced with difficulty
  1. Works toward achievement of goals even when confronted with obstacles.
  1. Directs team in prioritizing daily work activities
  1. Inspires and motivates co-workers to be productive and energetic at work

Managing Risk

Agree Unsure Disagree N/A
  1. Seeks to maintain the long-term viability of the Company.
  1. Recognizes that small changes may snowball into major events.
  1. Bases decisions on patterns found in fluid/changing information.
  1. Works within constraints of the organization.
  1. Avoids maintaining the status quo (or standard operating procedures) when addressing new and influential situations.

Developing Others

Agree Unsure Disagree N/A
  1. Creates opportunities for professional development.
  1. Recognizes and celebrates accomplishments of others.
  1. Assesses employees' developmental needs.
  1. Tries to ensure employees are ready to move to the next level.
  1. Encourages employees through recognition of positive changes in behavior.


Agree Unsure Disagree N/A
  1. Helpful
  1. Works effectively with people from other departments.
  1. Constructively receives criticism and suggestions from others.
  1. Is able to see issues from others' perspectives.
  1. Respects the opinions of other employees.

Global Perspective

Agree Unsure Disagree N/A
  1. Understands how cultures differ and how these differences impact work behavior.
  1. Sets the example for team on importance of cultural awareness.
  1. Considers customers point of view when making decisions.
  1. Applies knowledge of overseas markets.
  1. Can effectively deliver presentations to international clients.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

  4. Please give any final comments or suggestions for 's assessment.