Cultural Awareness - 360 Degree Feedback Survey Sample #1





360-Degree Feedback Survey

Questionnaires Measuring Cultural Awareness:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
Instructions:

[Company] is conducting a 360-Degree Feedback Assessment developed by HR-Survey for selected managers.

You have been selected to provide feedback on the employee listed above. Your feedback is an important part of our company's leadership development process and this survey is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the questions below, think about your experiences working with this employee over the last twelve months. The effectiveness of this development tool is dependent on your honest, forthright and constructive responses so please bear this in mind as you answer each question. Your responses will be aggregated with the responses received from others and discussed with the employee to foster growth and on-going development.

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.

Competencies Included:
Cultural Awareness, Leadership, Persuasion and Influence, Administrative Skill, Change Management, Juggling Multiple Responsibilities, Excellence, Responsible, Conflict Management, Strategic Insight, Fiscal Management
Sample Result Document:
Sample Results
Your feedback is valuable in helping the individual to understand how they are perceived and experienced by others and the impact their behavior has on people in the organization with whom they interact. Feedback received also acknowledges strengths and identifies areas for development.

Use the form below to provide your feedback. Each field and comment box requires a response before you can SUBMIT your final feedback.

Please ensure that your submission is made between . The survey will only be available during these dates.

Thank you for your participation in the survey. We look forward to seeing the analysis of your responses and we are hoping for 100% participation.

Management Team


Cultural Awareness

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Accepts individual differences.
  1. Develops skills and attitudes to bridge cultural differences.
  1. Shows respect in daily interactions
  1. Helps other employees to become more culturally sensitive.
If [Participant Name] were to make improvements in Cultural Awareness, what are your suggestions for how he/she can improve this?

Leadership

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Gives direct, constructive, and actionable feedback.
  1. Holds others accountable for their actions.
  1. Sits down regularly with employees to review their job performance.
  1. Sets specific, measurable, and challenging goals.
If [Participant Name] were to make improvements in Leadership, what are your suggestions for how he/she can improve this?

Persuasion and Influence

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Ensures stakeholders are involved in the decision making process.
  1. Communicates effectively with others.
  1. Seeks to obtain consensus or compromise.
  1. Able to express own goals and needs.
If [Participant Name] were to make improvements in Persuasion and Influence, what are your suggestions for how he/she can improve this?

Administrative Skill

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Has strong technical/computer skills.
  1. Implements and uses performance measures.
  1. Accurately implements contract provisions.
  1. Takes responsibility for decisions.
If [Participant Name] were to make improvements in Administrative Skill, what are your suggestions for how he/she can improve this?

Change Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Develops a strategy for implementing changes.
  1. Is a leading force driving changes.
  1. Able to get department employees to accept new changes.
  1. Develops plans for following through on the changes.
If [Participant Name] were to make improvements in Change Management, what are your suggestions for how he/she can improve this?

Juggling Multiple Responsibilities

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Organizes tasks for the most efficient order of completion.
  1. Ensures that assignments are prioritized according to the needs of the department/company.
  1. Integrates developing others with driving sales, serving customers, merchandising, performing operational procedures, and maintaining an appealing store environment.
  1. Builds in extra time in the schedule for unplanned events/occurrences.
If [Participant Name] were to make improvements in Juggling Multiple Responsibilities, what are your suggestions for how he/she can improve this?

Excellence

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Is planful and organized.
  1. Produces high quality work.
  1. Keeps themselves and others focused on constant improvement.
  1. Can be counted on to add value wherever they are involved.
If [Participant Name] were to make improvements in Excellence, what are your suggestions for how he/she can improve this?

Responsible

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Completes assigned work tasks.
  1. Holds herself / himself accountable to goals / objectives
  1. ...takes personal responsibility for results.
  1. Sets high personal standards of performance.
If [Participant Name] were to make improvements in Responsible, what are your suggestions for how he/she can improve this?

Conflict Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Identifies the root sources of conflict.
  1. Determines who has the autonomy (authority) to make the decisions necessary to end the conflict.
  1. Removes misperceptions that may be contributing to the conflict.
  1. Establishes roles and responsibilities.
If [Participant Name] were to make improvements in Conflict Management, what are your suggestions for how he/she can improve this?

Strategic Insight

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Recognizes the needs of customers.
  1. Works with others to develop insights into the resources and actions required to produce desired results.
  1. Lets employees know how their roles contribute toward the achievement of strategic company objectives.
  1. Anticipates business cycles and trends and makes adjustments in a timely manner.
If [Participant Name] were to make improvements in Strategic Insight, what are your suggestions for how he/she can improve this?

Fiscal Management

Needs
Improvement
Meets
Minimum
Standards
Is
Proficient
Role
Model
  1. Provides budgeting and accounting support to the Company.
  1. Ensures others follow the correct rules and regulations on fiscal matters.
  1. Effective in using Company's resources.
  1. Monitors spending.
If [Participant Name] were to make improvements in Fiscal Management, what are your suggestions for how he/she can improve this?

  1. What are [Participant Name Here]'s greatest strengths demonstrated this year?


  2. What are [Participant Name Here]'s areas for development?


  3. Please give any final comments or suggestions for [Participant Name Here]'s assessment.