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

• Evaluates the effectiveness of safety training through observation, feedback, and performance data.
• Ensures emergency exits, pathways, and safety equipment remain accessible at all times.
• Actively practices safety in the workplace.
• Creates new safety initiatives.
• Establishes and manages maintenance processes that keep materials-handling equipment safe and dependable.

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

Comments:

Results Oriented

• Inspires others by consistently demonstrating belief in the team's potential.
• Has a strong drive to complete goals despite obstacles that may arise.
• Anticipates customer needs and adjusts workflows to ensure satisfaction.
• Aligns team objectives with broader organizational priorities to ensure strategic coherence.
• Inspires and motivates co-workers to be productive and energetic at work

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

Comments:

Leadership

• Stands firm in the face of resistance when driving necessary change.
• Provides individual coaching for employees as needed.
• Is able to get the appropriate resources to support individual or team initiatives.
• Avoids vague statements; instead, explains what worked and why or what needs improvement and how.
• Influences others in a way that results in acceptance, agreement, or behavior change.

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

Comments:

Company

• Invests in technology and tools to help employees work better.
• Treats mistakes as learning opportunities, not punishable offenses.
• Supports [Company]'s strategic objectives.
• Ensures all voices are heard and valued, fostering a culture of inclusion and respect.
• Effectively represents the department in company gatherings.

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

Comments:

Problem Solving

• Strengthens team cohesion and communication to facilitate effective brainstorming sessions.
• Effective problem-solver
• Recognizes the challenges that have emerged or are about to emerge.
• Stays positive and driven despite obstacles.
• Understands the root causes of 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.