Safety - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

Instructions

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.

Safety

• Committed to safety in the workplace.
• Supports our company's safety programs.
• Is aware of OSHA safety guidelines.
• Participates in safety training as applicable.
• Develops a strong safety culture.

If [Participant Name] were to make improvements in Safety, what are your suggestions for how he/she can improve this?

Customer Focus

• Helps customers feel they are receiving services tailored specifically to their needs.
• Ensures all customer commitments and requirements are met or exceeded.
• Makes sure their interests are aligned with the customer's interests.
• Attends to the customer's needs in addition to the specific needs of the project.
• Asks questions and listens carefully to determine customer needs and to ensure that the customer's needs are met.

If [Participant Name] were to make improvements in Customer Focus, what are your suggestions for how he/she can improve this?

Strategic Insight

• Attends industry conferences to gain further insight into how other companies deal with similar issues.
• Recognizes the needs of customers.
• Ensures that the department's goals are strategically aligned with the company's goals.
• Implements long-term solutions to problems.
• Analyzes records and reports to obtain insight into potential issues and trends.

If [Participant Name] were to make improvements in Strategic Insight, what are your suggestions for how he/she can improve this?

Accountability

• Informs supervisor of progress without having to be asked about it.
• Provides clear reasons for underperformance.
• Accepts accountability for their work.
• Takes responsibility for errors in the production line.
• Is personally invested in the success of the organization.

If [Participant Name] were to make improvements in Accountability, what are your suggestions for how he/she can improve this?

Initiative

• Inspires others to perform above expectations.
• Takes action to establish clear and concise deadlines for tasks to be completed.
• Coach others to foster an environment which can adapt quickly and willingly to rapid change.
• Is a self-starter. Does not wait to be told to do something.
• Immediately informs the supervisor of any critical incidents.

If [Participant Name] were to make improvements in Initiative, what are your suggestions for how he/she can improve this?

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

5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

Strengths


Areas for Development


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