Safety - 360 Degree Feedback Survey Sample #9

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)

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing development.

Partially completed forms can be saved by using the Save/Still Working button at the bottom of the page. You may return at a later time to complete/edit the form. Your saved responses will be shown each time you re-visit the feedback form. When you are certain that you have completed your responses and will be not making any changes, click the Complete button.


Definite Strength Meets Standards Needs Development N/A
  1. Committed to safety in the workplace.
  1. Ensures that all supervisors are aware of regulatory and compliance measures.
  1. Develops a sustainable safety culture.
  1. Is aware of OSHA safety guidelines.
  1. Participates in safety training as applicable.


Definite Strength Meets Standards Needs Development N/A
  1. Recognizes and implements changes to enhance efficiency and effectiveness.
  1. Develops insights and applies innovative solutions to projects and problems.
  1. Works effectively in dynamic and changing work environments.
  1. Ability to recognize the potential benefits of change, and create an infrastructure which supports change.
  1. Is proactive and takes steps to prepare for changes in the workplace.

Professional Development

Definite Strength Meets Standards Needs Development N/A
  1. Encourages employees to take courses relevant to their job.
  1. Quickly acquire and apply new knowledge and skills when needed
  1. Demonstrate enthusiasm and a willingness to learn new skills and knowledge
  1. Contributing fully to the extent of their skills
  1. Allows employees to fully participate in employee training and professional development.

Cultural Awareness

Definite Strength Meets Standards Needs Development N/A
  1. Recognizes and values individual and cultural differences.
  1. Maintains an inclusive work environment that maximizes the talents of others in achieving goals.
  1. Values the opinions of diverse groups and individual.
  1. Seeks out different viewpoints and benefits from different perspectives.
  1. Respects others regardless of age, race, gender, nationality, or disability.


Definite Strength Meets Standards Needs Development N/A
  1. Encourages and empowers subordinates to use initiative in achieving goals and objectives.
  1. Sets clear and reasonable expectations for others and follows through on their progress.
  1. Defines the roles, responsibilities, required actions, and deadlines for team members.
  1. Delegates tasks, responsibilities, and accountability as appropriate to the level of employee.
  1. Allows subordinates to use their own methods and procedures.

Decision Making

Definite Strength Meets Standards Needs Development N/A
  1. Assesses the risks, benefits, and potential impact of a number of options when deciding a course of action
  1. Seeks input from key people who should be involved in, or will be affected by, decisions
  1. Breaks complex issues into manageable parts and organizes them in a systematic way before making decisions
  1. Coaches team members individually when "poor" decisions are made; helps them see what could have been done differently
  1. Asks for additional information when making critical decisions.

Change Management

Definite Strength Meets Standards Needs Development N/A
  1. Assists others in understanding changes to the organization.
  1. Addresses organizational and departmental resistance to changes.
  1. Effective in implementing new organizational vision and values.
  1. Supports new initiatives for organizational changes to improve effectiveness.
  1. Supports the Company's efforts to implement changes.


Definite Strength Meets Standards Needs Development N/A
  1. Demonstrates mastery of the technical competencies required in his/her work.
  1. Is knowledgeable of procedures or systems necessary for the job.
  1. Keeps current with technical advances within his/her professional discipline; embraces and applies new techniques and practices
  1. Knows how to produce high quality products/work.
  1. Is naturally sought out by people outside his/her particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.

Client Focus

Definite Strength Meets Standards Needs Development N/A
  1. Forms strong client relationships
  1. Is pro-active in dealing with clients and addressing their needs.
  1. Ensures client commitments and requirements are met or exceeded
  1. Maintains strong relationships with clients.
  1. Obtains feedback to ensure client needs are being met.


Definite Strength Meets Standards Needs Development N/A
  1. Act as an effective team player
  1. Coaches team members to work toward a common goal.
  1. Facilitates team discussions and problem-solving
  1. Shares credit for accomplishments with team members
  1. Fosters teamwork rather than individual competition

Organizational Fluency

Definite Strength Meets Standards Needs Development N/A
  1. Gets things done through the department.
  1. Adept at navigating within the culture of the department.
  1. Effective in communicating with others within the organization.
  1. Understands departmental policies and procedures.
  1. Able to explain departmental policies and procedures to others.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

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