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
Ensures compliance with safety regulations.
Investigates the root causes of safety incidents.
Sets training goals for the department/organization.
Maintains accurate records regarding safety incidents and accidents.
Conducts risk assessments to identify potential disaster scenarios and their impacts.
Ensures others are able to work safely.
Designs and delivers effective health and safety training programs.
Assesses critical operations and identifies resources needed to maintain or restore them after a disaster.
Ensures employees participate in the safety training process.
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
Uses data and metrics to evaluate performance and guide accountability conversations.
Has a strong result orientation.
Prioritizes tasks based on impact and urgency to optimize resource allocation.
Responds to changing events to maintain progress toward achieving results.
Celebrates team achievements to reinforce a culture of excellence.
Sets benchmarks and milestones to measure progress toward the objectives.
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
Avoids promoting a hyper competitive culture in favor of a more collaborative one.
Integrates digital tools to streamline the collaborative processes of Research and Development.
Encourages working together to achieve shared goals.
Participates in collaborative/team decision-making.
Builds strong interpersonal relationships for more effective collaboration.
Creates an environment that encourages information sharing.
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
Handles sensitive information with discretion and care.
Consistently behaves in ways that reinforce trust.
Builds and maintains the trust of others.
Sets the tone by demonstrating the behaviors others should emulate.
Owns decisions and their consequences, whether positive or negative.
Treats all individuals with fairness, dignity, and respect.
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
Treats all employees equitably, regardless of role, background, or tenure.
Maintains positive relationships between the [Company] and government agencies.
Ensures that employees feel a sense of accomplishment and purpose.
Provides a workspace that is comfortable and conducive to long hours of work.
Translates company-wide initiatives into actionable goals for the team.
Ensures employees have all the tools and equipment needed to maintain production schedules.
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
Places trust in subordinates to succeed.
Sets clear goals and objectives for subordinates.
Gains commitment by persuasion.
Inspires confidence by demonstrating conviction, authenticity, and passion for ideas.
Provides employees with the authority and resources needed to make decisions within their roles.
Encourages peer-to-peer feedback and open communication across the team.
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
Determines the order in which the action steps need to be completed including steps that may be dependent on others.
Analyzes alternatives and selects a course of action.
Measures the solution's impact on the desired outcomes and identifyies any deviations from the expected performance.
Makes judgments based upon relevant information.
Has the ability to compare "best practice" performance to current situation and affect improvements.
Clearly articulates expected outcomes and the current situation to foster a shared understanding of the problem among stakeholders.
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.