Health & Safety Leadership Survey

Health & Safety Leadership Survey
This checklist is designed to help you identify safety leadership areas of strength and safety leadership areas you may wish to include on your personal development plan. You may choose to have your immediate supervisor, peers, or direct reports use the checklist to provide feedback and then compare results to understand the perceptions of your work team. Used in this manner, the Leadership Checklist can be a powerful tool in facilitating feedback about gaps in behaviors necessary for optimizing safety leadership performance. The feedback received from using this checklist can also be shared with your mentor to work toward addressing professional growth areas.
Employee Assessment for:
Employees which submissions should be sent to:
Indicate below whether the behavior associated with each competency is exhibited in the workplace.

Competency 1: Mentors Others

	Always	Very Often	Sometimes	Rarely	Never
Provides ongoing corrective and positive feedback to all safety leaders on key competencies	1	2	3	4	5
Helps leaders consider the impact of their actions on the safety of others as well as on the organizations safety culture	6	7	8	9	10
Helps others be successful in leading their employees through listening, observing, coaching, and action planning	11	12	13	14	15
Foster a sense that leaders are responsible for the safety of their employees	16	17	18	19	20

Competency 2: Communicates

	Always	Very Often	Sometimes	Rarely	Never
Shares the reasons and background for safety policies and procedures with employees	21	22	23	24	25
Encourages people to give honest and complete information about safety	26	27	28	29	30
Makes safety goals, initiatives, and plans clear through frequent employee contacts	31	32	33	34	35
Makes sure others feel comfortable and safe when communicating issues and concerns	36	37	38	39	40
Inspires enthusiasm by publicly valuing the contributions and participation of others	41	42	43	44	45
Is clear about employee expectations to demonstrate safe behaviors and follow practices	46	47	48	49	50
Describes a compelling picture of what the future could be	51	52	53	54	55

Competency 3: Listens

	Always	Very Often	Sometimes	Rarely	Never
Listens to other’s ideas and suggestions	56	57	58	59	60
Open to constructive feedback on competencies and safety practices	61	62	63	64	65
Seeks guidance from safety experts	66	67	68	69	70
Seeks out listens to diverse points of view about safety	71	72	73	74	75
Be present when engaging employees	76	77	78	79	80

Competency 4: Leads with purpose

	Always	Very Often	Sometimes	Rarely	Never
Identifies critical safe behaviors and make a deliberate effort to observe them	81	82	83	84	85
Is proactive rather than reactive in addressing safety issues	86	87	88	89	90
Seizes safety improvement opportunities when they arise	91	92	93	94	95
Promotes cooperation and collaboration in safety	96	97	98	99	100
Considers safety in every decision	101	102	103	104	105
Holds people accountable for safety commitments	106	107	108	109	110
Leads by example	111	112	113	114	115
Personal direction and focus	116	117	118	119	120

Competency 5: Acts with integrity

	Always	Very Often	Sometimes	Rarely	Never
Takes responsibility for actions and admits to mistakes	121	122	123	124	125
Not self-promoting or arrogant	126	127	128	129	130
Demonstrates employee safety is more important than employee production	131	132	133	134	135
Places no blame for near miss reporting	136	137	138	139	140
Honest	141	142	143	144	145

Competency 6: Credibility

	Always	Very Often	Sometimes	Rarely	Never
Uses ethical considerations to guide safety decisions	146	147	148	149	150
Follows through on safety promises	151	152	153	154	155
Demonstrates care and concern for employees	156	157	158	159	160
Gives honest information about safety performance (even if it is not well received)	161	162	163	164	165

Competency 7: Develops employees

	Always	Very Often	Sometimes	Rarely	Never
Helps employees consider the impact of their actions on the safety of others as well as on the organizations safety culture	166	167	168	169	170
Asks more and tells less - Asks questions to uncover learning	171	172	173	174	175
Coaches employees to improve performance	176	177	178	179	180
Help employees change their view of how things are done and to think creatively about how to do things differently	181	182	183	184	185
Provides guidance when needed	186	187	188	189	190
Encourages peer to peer safety observations and feedback	191	192	193	194	195

Open text box for comments
Competency 8: Seeks or uses feedback
Always Very Often Sometimes Rarely Never
Learns from experience 196 197 198 199 200
Pursues feedback 201 202 203 204 205

	Always	Very Often	Sometimes	Rarely	Never
Learns from experience	196	197	198	199	200
Pursues feedback	201	202	203	204	205

Competency 9: Motivates others

	Always	Very Often	Sometimes	Rarely	Never
Recognizes individual contributions for safety work well done	206	207	208	209	210
Finds ways to celebrate accomplishments in safety	211	212	213	214	215
Publicly recognizes the safety related contributions of individuals	216	217	218	219	220
Demonstrates a sense of personal urgency and energy to achieve safety results	221	222	223	224	225

Competency 10: Builds relationships

	Always	Very Often	Sometimes	Rarely	Never
Makes an effort to get to know employees on a personal level	226	227	228	229	230
Demonstrates concern and consideration for employees well being	231	232	233	234	235
Networks with other safety leaders	236	237	238	239	240
Treats people fairly	241	242	243	244	245