Safety - 360 Degree Feedback Survey Sample #10

360 Feedback Survey

Instructions

We appreciate you taking the time to provide valuable feedback for the individual mentioned above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Your insights are crucial in offering a comprehensive evaluation. Please rate each item using the scale provided. If you find that you do not have sufficient first-hand knowledge to rate a particular item, select the Not Applicable option.

In addition to the ratings, we encourage you to include comments where possible. These comments are particularly useful when you give a very high or very low rating, as they provide context and clarity regarding your assessment. Explaining your reasons in the comment section helps ensure that your feedback is constructive and actionable.

Your responses, combined with feedback from other contributors, will be compiled and presented to the individual. This collective feedback aims to support their continuous growth and development by highlighting strengths and identifying areas for improvement. Your thoughtful participation is essential in helping them achieve their full potential.

You can save your progress on partially completed forms by clicking the Save/Still Working button located at the bottom of the page. This allows you to come back at a later time to finish or make any necessary edits to the form. When you return, your previously saved responses will automatically be displayed, allowing you to seamlessly continue where you left off. When you have completed filling out the form and are confident that no further changes are needed, please click the Complete button.

Safety

• Commits adequate resources toward safety measures.
• Seeks to reduce the likelihood of accidents.
• Performs work safely.
• Is not afraid to question a potential safety issue observed in the workplace.
• Identifies predictable hazards in the workplace.

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

Customer Focus

• Transparent in all communications with the customer.
• Creates customized solutions for the customer.
• Provides excellent service to customers.
• Builds trust with the customer.
• Uses customer feedback to help improve products and services.

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

Strategic Insight

• Recognizes the needs of customers.
• Implements long-term solutions to problems.
• Inspires employees to adopt the strategic plan.
• Observes employees at work to get better insight into the issues they are dealing with.
• Creates a vision for the organization based on insights gathered from other companies in the industry.

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

Accountability

• Accepts personal responsibility for the timeliness of work.
• Chooses integrity over convenience.
• Accepts personal responsibility for not meeting expectations.
• Defines roles, rights, and responsibilities of the team.
• Regularly leads the way when helping the team troubleshoot various issues.

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

Initiative

• Takes on additional tasks without being asked or told to do so.
• Acts independently to solve pressing needs.
• Quickly comes to the aid of those who may need help.
• Seizes upon opportunities available.
• Immediately works on solving problems.

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.