Safety - 360 Degree Feedback Survey Sample #14

360 Feedback Survey

Instructions

Our company is excited to introduce a new web-based survey tool designed to gather comprehensive feedback on core competencies and role responsibilities critical to the ongoing success of our organization. The Leadership Team Members have unanimously agreed to participate in this initiative and are actively seeking your valuable feedback.

In this context, you have been specifically selected to provide insights on the manager listed above. Your feedback is a crucial component of our company's leadership development process. This tool is intended to capture broad and detailed feedback on the essential competencies and responsibilities that underpin our organization's sustained success and growth.

Your thoughtful and candid responses will play a significant role in guiding the professional development of our leadership team. By reflecting on your experiences and interactions with the manager over the past six to twelve months, you will help us identify strengths, areas for improvement, and opportunities for growth. Your feedback will be combined with that of others and presented to the manager to support their ongoing development. Rest assured, your comments will be shared anonymously, ensuring your privacy while contributing to a culture of continuous improvement and excellence.

In responding to the assessment form, please think about your experiences working with this individual during the last twelve (12) months. Your responses will be merged with other people's feedback and presented to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager, unless you indicate otherwise.

You are only being asked to rate 8 competencies. Each competency will have a variety of statements that are grouped by 4 Performance Levels. Click on the level that best describes this individual.

Please ensure that your submission is made between .

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Safety	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Committed to safety in the workplace.
Keeps accurate safety records.
Seeks to reduce the likelihood of accidents.
Ensures that all supervisors are aware of regulatory and compliance measures.
Mitigates hazards and safety issues that arise.
Is aware of OSHA safety guidelines.
Performs work safely.
Commits adequate resources toward safety measures.
Is not afraid to question a potential safety issue observed in the workplace.
If [Participant Name] were to make improvements in Safety, what are your suggestions for how he/she can improve this?
Results Oriented	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Completes all assigned tasks.
Works hard despite obstacles that impede progress.
Sets important goals for the department.
Stays focused on solving problems and getting work done.
Directs team in prioritizing daily work activities
Holds others accountable for producing high quality work.
If [Participant Name] were to make improvements in Results Oriented, what are your suggestions for how he/she can improve this?
Collaboration	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Equip the team with the right tools and technologies to facilitate collaboration.
Collaborates with team members to achieve common goals.
Actively seeks opportunities to work with colleagues to address and resolve challenges.
Builds consensus among team members.
Integrates technology to boost collaborative work on process and policy documentation.
Seeks continuous improvement through the input from coworkers and staff.
If [Participant Name] were to make improvements in Collaboration, what are your suggestions for how he/she can improve this?
Trustworthy	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Communicates an understanding of the other person's interests, needs and concerns.
Is trustworthy; is someone I can trust.
Consistently keeps commitments.
Takes care to maintain confidential information.
Demonstrates a sense of responsibility and commitment to public trust.
Demonstrates congruence between statements and actions.
If [Participant Name] were to make improvements in Trustworthy, what are your suggestions for how he/she can improve this?
Company	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Expresses loyalty and dedication to [Company] in interactions with others.
Understands the "basics" as to how [Company] functions/operates.
Understands the use of [Company] products and services.
Follows existing procedures and processes.
Understands how decisions impact other business units beyond their immediate department of work group.
Impresses upon others the important aspects of [Company].
If [Participant Name] were to make improvements in Company, what are your suggestions for how he/she can improve this?
Leadership	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Gives direct, constructive, and actionable feedback.
Guides decision-making by coaching, counseling and rewarding.
Gives inspiring presentations or discussions.
Is a highly effective supervisor.
Motivates others to reach and exceed organizational goals and objectives.
Acts decisively in implementing decisions.
If [Participant Name] were to make improvements in Leadership, what are your suggestions for how he/she can improve this?
Problem Solving	Needs Improvement	Could Benefit from Development	Performs as Expected	Is a Role Model for Others	Don't Know
Solves problems at root cause rather than at symptom level.
Remains resilient and motivated when encountering challenges or setbacks.
Stays positive and driven despite obstacles.
Sets realistic deadlines for each action step and for the overall completion of the solution.
Compares analogous situations transferring insights to new situations.
Brings together individuals with different backgrounds, skills, and viewpoints, brainstorming harnesses a wide range of insights.
If [Participant Name] were to make improvements in Problem Solving, what are your suggestions for how he/she can improve this?

46. Strengths
    
    
    
47. Areas for Development
    
    
    
48. Please give any final comments or suggestions for [Participant Name Here]'s assessment.