Safety - 360 Degree Feedback Survey Sample #12





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)
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

  • Develops a strong safety culture.
  • Committed to safety in the workplace.
  • Mitigates hazards and safety issues that arise.
  • Develops a culture of safety.
  • Is aware of OSHA safety guidelines.
Needs
Improvement
Fully
Proficient
Excels/
Role Model






Click this box to make your rating
Comments:

Results Oriented

  • Is considered a high achiever.
  • Creates measures of performance to track progress.
  • Makes sure employees have the resources they need to achieve their results.
  • Strives to exceed performance benchmarks.
  • Has a work ethic with a strong desire to obtain results.
Needs
Improvement
Fully
Proficient
Excels/
Role Model






Click this box to make your rating
Comments:

Leadership

  • Effectively leads others.
  • Gives inspiring presentations or discussions.
  • Holds others accountable for their actions.
  • Expresses clear goals and objectives.
  • Recognizes individual and team accomplishments and reward them appropriately.
Needs
Improvement
Fully
Proficient
Excels/
Role Model






Click this box to make your rating
Comments:

Company

  • Understands the "basics" as to how [Company] functions/operates.
  • Follows existing procedures and processes.
  • Expresses loyalty and dedication to [Company] in interactions with others.
  • Attends [Company] gatherings and social events.
  • 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

  • Implements effective solutions to critical problems.
  • Identifies and assesses all potential responses to a problem.
  • Finds creative ways to get things done with limited resources.
  • Able to balance the needs of different people in a solution to a problem.
  • Solves problems using logic and insight.
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.