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

• Develops a sustainable safety culture.
• Supports our company's safety programs.
• Supports safety programs and procedures.
• Performs work safely.
• Keeps accurate safety records.

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

Customer Focus

• ...friendliness and courtesy
• Does not hesitate to address customer concerns or complaints.
• Consistently models positive customer service attitudes.
• Develops strong customer relationships.
• Develops good rapport and trust with the customer.

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

Strategic Insight

• Identifies root causes of problems.
• Communicates vision for the department and company.
• Implements long-term solutions to problems.
• Formulates strategies and action plans to ensure successful completion of goals and objectives.
• Understands the Company's strengths and weaknesses and uses this information to create optimal solutions to problems.

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

Accountability

• Implements and facilitates controls and processes that maintain the integrity of the organization.
• Keeps their word and does what they say they will do.
• Accepts accountability for their actions and results.
• Keeps supervisor informed of recent events.
• Develops goals and establishes objective measures of success.

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

Initiative

• Immediately works to complete goals well before their deadline.
• Seeks and utilizes opportunities for continuous learning and self-development.
• Prepares for unexpected contingencies.
• Takes the initiative to change the direction or course of events.
• Goes above and beyond the stated goals.

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.