Safety - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

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)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)

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.

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

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


What does Safety mean?
It means that ...
  • You are committed to safety in the workplace.
  • You seek to reduce the likelihood of accidents.
  • You identify and addresses safety needs.
  • You are not afraid to question a potential safety issue observed in the workplace.
  • You encourage others to work safely.

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

Passion To Learn

What does Passion To Learn mean?
It means that ...
  • You are motivated by the desire to be "the best".
  • You take initiative for own learning and development.
  • You constantly enhance product knowledge through experimentation and play.
  • You recognize own areas for development and consciously seek assignments that will provide practice in areas of developmental need.
  • You persist until goals are achieved and commitments are met.

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

Project Management

What does Project Management mean?
It means that ...
  • You maintain costs and expenses within budget limits.
  • You anticipate potential problems and institute controls and contingency plans to address them.
  • You are able to adjust project schedule as needed to accommodate unforeseen issues.
  • You develop action items, workplans, timelines, and criteria for projects.
  • You organize, plan, and direct resources to accomplish the goals and objectives.

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


What does Technical mean?
It means that ...
  • You willingly share information and expertise; sought out as resource by others
  • You know how to produce high quality products/work.
  • You use expertise to identify issues and think through creative solutions to get a problem solved or objective accomplished.
  • You seek information from others as needed.
  • You demonstrate mastery of the technical competencies required in your work.

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


What does Partnering/Networking mean?
It means that ...
  • You seek an understanding of diverse functions within the Company.
  • You support a partnering/networking culture.
  • You promote the understanding of how the department affects the organization overall.
  • You develop a sense of trust in subordinates so they can freely interact and share information with others.
  • You maintain infrastructure to support partnerships and networks.

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

Areas for Development

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