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

• Participates in safety training when available.
• Encourages others to work safely.
• Seeks to reduce the likelihood of accidents.
• Develops a sustainable safety culture.
• Works to implement corrective safety measures.

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

Comments:

Results Oriented

• Sets objectives for the department.
• Is a high achiever.
• Sets important goals for the department.
• Views obstacles as opportunities to improve self.
• Stays focused on meeting the needs of customers.

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

Comments:

Leadership

• Highly effective supervisor.
• Able to align manpower, design work, an allocate tasks to achieve goals.
• Effectively leads others.
• Takes ownership and accountability for results
• Expresses clear goals and objectives.

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 "basics" as to how [Company] functions/operates.
• 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

• Makes judgments based upon relevant information.
• Identifies and assesses all potential responses to a problem.
• Works cooperatively with others to solve problems.
• Solves problems using logic and insight.
• 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.