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

• Ensures compliance with safety regulations.
• Encourages others to attend safety training.
• Encourages others to work safely.
• Identifies predictable hazards in the workplace.
• Participates in safety training when offered.

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

Comments:

Results Oriented

• Stays focused on meeting the needs of customers.
• Sets priorities for tasks to be completed.
• Achieves high levels of performance.
• Ensures the team understands the objective that needs to be completed.
• Directs team in prioritizing daily work activities

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

Comments:

Leadership

• Acts decisively in implementing decisions.
• Guides decision-making by coaching, counseling and rewarding.
• Leads team to set goals, solve problems, and accomplish tasks.
• Recognizes individual and team accomplishments and reward them appropriately.
• Highly effective supervisor.

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

Comments:

Company

• Expresses loyalty and dedication to [Company] in interactions with others.
• Attends [Company] gatherings and social events.
• Understands how decisions impact other business units beyond their immediate department of work group.
• Understands the use of [Company] products and services.
• Impresses upon others the important aspects of [Company].

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

Comments:

Problem Solving

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

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.