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)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)

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.

Sample Result Document:
Sample Results
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. Supports our company's safety programs.
  1. Ensures that all supervisors are aware of regulatory and compliance measures.
  1. Is aware of OSHA safety guidelines.
  1. Develops a culture of safety.
  1. Develops safety guidelines for the department.

Continual Learning

Agree Unsure Disagree N/A
  1. Grasps new ideas, concepts, technical, or business knowledge.
  1. Shares best practices with others and learns from others.
  1. Improves on their skill sets.
  1. Takes charge of their training and skills enhancement.
  1. Pursues professional development opportunities when they arise.

Professional Development

Agree Unsure Disagree N/A
  1. Encourages employees to take courses relevant to their job.
  1. Seeks opportunities for professional development.
  1. Quickly acquire and apply new knowledge and skills when needed
  1. Contributing fully to the extent of their skills
  1. Keep themselves up-to-date of technical/professional issues

Emotional Intelligence

Agree Unsure Disagree N/A
  1. Is able to express themselves clearly.
  1. Accurately perceives the emotional reactions of others.
  1. Is able to control their own emotions.
  1. Able to understand others' points of view.
  1. Helps employees to resolve conflicts, communicate clearly, and work together to solve problems.


Agree Unsure Disagree N/A
  1. Understands & contributes to development of strategic goals.
  1. Makes sure that I have a clear idea of our group's goals.
  1. Sets high expectations and goals; encourages others to support the organization.
  1. Achieves established goals.
  1. Makes sure that team members have a clear idea of our group's goals.

Results Oriented

Agree Unsure Disagree N/A
  1. Provides clear expectations for employees.
  1. Inspires and motivates co-workers to be productive and energetic at work
  1. Works toward achievement of goals even when confronted with obstacles.
  1. Helps others when free-time is available.
  1. Directs team in prioritizing daily work activities

Managing Risk

Agree Unsure Disagree N/A
  1. Evaluates risks against acceptable risk levels.
  1. Accurately determines appropriate risk levels (i.e., levels of acceptable risk).
  1. Seeks to increase safety in the workplace.
  1. Accurately perceives potential risks in the workplace and initiates preventative measures.
  1. Is aware of process safety management.

Developing Others

Agree Unsure Disagree N/A
  1. Encourages employees through recognition of positive changes in behavior.
  1. Creates a work environment that fosters positive feedback to employees.
  1. Assigns tasks and responsibilities to develop skills of others.
  1. Supports the successes of other employees.
  1. Creates opportunities for professional development.


Agree Unsure Disagree N/A
  1. Forms working relationships with employees from other departments.
  1. Supports the efforts of other employees in implementing solutions to problems.
  1. Able to see issues from others' perspectives.
  1. Works across boundaries within the organization.
  1. Constructively receives criticism and suggestions from others.

Global Perspective

Agree Unsure Disagree N/A
  1. Understands global systems such as the global economy.
  1. Applies knowledge of overseas markets.
  1. Develops both the cultural awareness and business skills to grow our business in all countries, and work effectively across borders with employees, customers, and shareowners.
  1. Collaborates with others respectfully and effectively with other people regardless of differences in cultural backgrounds.
  1. Able to work with others from different cultures and countries.

  1. Overall, please rate the effectiveness of [Participant Name Here].

  2. Strengths

  3. Areas for Development

  4. Please give any final comments or suggestions for [Participant Name Here]'s assessment.