Safety - 360 Degree Feedback Survey Sample #12

360 Feedback Survey

Instructions

We appreciate you taking the time to provide valuable feedback for the individual mentioned above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Your insights are crucial in offering a comprehensive evaluation. Please rate each item using the scale provided. If you find that you do not have sufficient first-hand knowledge to rate a particular item, select the Not Applicable option.

In addition to the ratings, we encourage you to include comments where possible. These comments are particularly useful when you give a very high or very low rating, as they provide context and clarity regarding your assessment. Explaining your reasons in the comment section helps ensure that your feedback is constructive and actionable.

Your responses, combined with feedback from other contributors, will be compiled and presented to the individual. This collective feedback aims to support their continuous growth and development by highlighting strengths and identifying areas for improvement. Your thoughtful participation is essential in helping them achieve their full potential.

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.

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Safety

• Commits adequate resources toward safety measures.
• Points out behaviors in others that may be unsafe.
• Creates accurate and effective measures of safety.
• Develops safety guidelines for the department.
• Mitigates hazards and safety issues that arise.

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

Comments:

Results Oriented

• Is considered a high achiever.
• Establishes benchmarks to be met when working on projects.
• Is a high achiever.
• Completes all assigned tasks.
• Concentrates efforts on the most urgent needs.

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

Comments:

Leadership

• Effectively leads others.
• Sits down regularly with employees to review their job performance.
• 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.
• Sets clear goals and objectives for subordinates.
• Able to organize the work of others.

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

Comments:

Company

• 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.
• 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

• Acknowledges the unique viewpoints and perspectives of other team members to lead to more innovative and comprehensive solutions.
• Generates alternative solutions to problems and challenges.
• Pinpoints the issues that have arisen or are expected to arise.
• Establishes a timeline for implementation and organizes the needed supplies and equipment.
• Uses charting tools to identify patterns in data.

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.