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. Supports and mentors others that may have different cultural backgrounds.
  1. Treats others with dignity and respect.
  1. Helps other employees to become more culturally sensitive.
  1. Interacts effectively with people from different cultural backgrounds.
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. Sets specific, measurable, and challenging goals.
  1. Motivates and challenges employees to attain a shared vision.
  1. Gives direct, constructive, and actionable feedback.
  1. Highly effective supervisor.
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. Has excellent influencing/negotiating skills.
  1. Develops a good rapport with others.
  1. Understanding what others need.
  1. Persuades others to consider alternative points of view.
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. Able to develop, justify and present a budget.
  1. Enthusiastic about taking on challenging projects.
  1. Accurately implements contract provisions.
  1. Strong organizational skills to keep the workspace and department in order
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. Effective in implementing new organizational vision and values.
  1. Supports new initiatives for organizational changes to improve effectiveness.
  1. Develops plans for following through on the changes.
  1. Develops a strategy for implementing 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. Ensures that assignments are prioritized according to the needs of the department/company.
  1. Observes, analyzes, and responds to merchandise needs while serving customers and accomplishing operational tasks.
  1. Uses a scheduler/planner to keep tasks organized and on time.
  1. Avoids bottlenecks in progress by assigning multiple individuals to critical tasks.
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. Demonstrates the functional or technical skills necessary to do their job.
  1. Produces high quality work.
  1. Demonstrates the analytical skills to do their job.
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. ...takes personal responsibility for results.
  1. Holds herself / himself accountable to goals / objectives
  1. Responsible for setting the vision of the department.
  1. Behavior is ethical and honest.
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. Deals effectively with employee grievances.
  1. Assists team members by helping them see the other point of view.
  1. Discusses conflict situations with supervisor.
  1. Tries to understand others' point of view before making judgments
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. Anticipates business cycles and trends and makes adjustments in a timely manner.
  1. Inspires employees to adopt the strategic plan.
  1. Observes employees at work to get better insight into the issues they are dealing with.
  1. Creates a mission statement describing the purpose for the organization.
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. Effectively manages appropriations, reporting, purchases, expenditures, payrolls, and staff.
  1. Monitors spending.
  1. Keeps excellent records for financial transparency.
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.