Safety - 360 Degree Feedback Survey Sample #12

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.

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

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

Safety

• Works to implement corrective safety measures.
• Participates in safety training when offered.
• Supports safety programs and procedures.
• Develops a strong safety culture.
• Participates in safety training when available.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Results Oriented

• Explains the "whys" behind organizational objectives
• Works toward achievement of goals even when confronted with obstacles.
• Stays focused on meeting the needs of customers.
• Helps others when free-time is available.
• Inspires and motivates co-workers to be productive and energetic at work

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Leadership

• Effectively leads others.
• Demonstrates leadership and courage in critical situations.
• Clearly explains performance expectations and goals to be reached at the beginning of a project, then let's others decide how to achieve the goal.
• Gives direct, constructive, and actionable feedback.
• Able to influence others.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Company

• Impresses upon others the important aspects of [Company].
• Understands the use of [Company] products and services.
• Understands how decisions impact other business units beyond their immediate department of work group.
• Understands the "basics" as to how [Company] functions/operates.
• Follows existing procedures and processes.

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Problem Solving

• Works cooperatively with others to solve problems.
• Effective in solving problems.
• Able to balance the needs of different people in a solution to a problem.
• Identifies and assesses all potential responses to a problem.
• Is a good problem solver and decision maker

Needs Improvement		Fully Proficient		Excels/ Role Model
Click this box to make your rating

Comments:

Strengths


Areas for Development


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