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

• Encourages others to attend safety training.
• Encourages others to work safely.
• Participates in safety training when available.
• Develops a culture of safety.
• Ensures that all supervisors are aware of regulatory and compliance measures.

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.
• Works toward achievement of goals even when confronted with obstacles.
• Helps others when free-time is available.
• Directs team in prioritizing daily work activities
• Provides clear expectations for employees.

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

Comments:

Leadership

• Sits down regularly with employees to review their job performance.
• Recognizes individual and team accomplishments and reward them appropriately.
• Highly effective supervisor.
• Able to align manpower, design work, an allocate tasks to achieve goals.
• Able to organize the work of others.

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

Comments:

Company

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

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
• Works cooperatively with others to solve problems.
• Identifies and assesses all potential responses to a problem.
• Implements effective solutions to critical problems.
• Ability to solve problems at root cause rather than at symptom level.

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.