Safety - 360 Degree Feedback Survey Sample #11

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.

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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

Safety

What does Safety mean?
It means that ...

• You work to implement corrective safety measures.
• You develop a culture of safety.
• You participate in safety training as applicable.
• You develop a sustainable safety culture.
• You commit adequate resources toward safety measures.

To what extent does this person exhibit Safety?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Passion To Learn

What does Passion To Learn mean?
It means that ...

• You create an environment that supports personal development and exploration.
• You embrace new technology and procedures.
• You recognize own areas for development and consciously seek assignments that will provide practice in areas of developmental need.
• You exhibit willingness to upgrade skills through additional training and education.
• You stay up-to-date on emerging technologies.

To what extent does this person exhibit Passion To Learn?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Project Management

What does Project Management mean?
It means that ...

• You investigate potential risks of different courses of action.
• You establish the sequence of steps needed to complete the project.
• I manage various facets of the project to keep it on track with the delivery date.
• You procure the resources necessary to complete the project.
• You understand the budget constraints for the project.

To what extent does this person exhibit Project Management?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Technical

What does Technical mean?
It means that ...

• You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
• You know how to produce high quality products/work.
• You are naturally sought out by people outside your particular area for advice and opinion on a broad range of matters - not necessarily solely legal advice.
• You seek information from others as needed.
• You are knowledgeable of procedures or systems necessary for the job.

To what extent does this person exhibit Technical?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Partnering/Networking

What does Partnering/Networking mean?
It means that ...

• I plan and engage resources to the partnership effort while monitoring and evaluating progress and achievements.
• You develop important industry contacts to facilitate business goals.
• I am comfortable working in partnership with colleagues from other departments.
• I implement effective oversight of network activities.
• You provide or participate in joint ventures or co-development projects.

To what extent does this person exhibit Partnering/Networking?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Strengths


Areas for Development


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