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Cultural Awareness - 360 Degree Feedback Survey Sample #2





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)
Survey 13 (4-point scale; numbers; floating anchors)
Survey 14 (4-point scale; N/A)
Self-Assessment Instructions

You have been asked to complete a self-assessment questionnaire form (shown below). You will also receive feedback from others such as your peers, direct reports and manager. 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 as an employee over the last twelve months and the goals you were asked to achieve. 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 become part of the assessment process to foster your growth and on-going development.

Competencies Included:
Cultural Awareness, Managing Performance, Creativity, Feedback, Attitude, Decision Making, Innovation, Achievement, Clarity, Customer Focus, Recognition, Business Acumen
Sample Result Document:
Sample Results
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.

Please ensure that your submission is made between . The survey will only be available during these dates.
Edit this Survey
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Cultural Awareness

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I participate in cultural training sessions/classes.
  1. You engage with individuals that have different cultural backgrounds.
  1. You encourage a work environment where individual differences are valued.
  1. I intervene respectfully when witnessing culturally insensitive behavior or language.
  1. You understand what customs and etiquette are important for individuals from other cultures.
What are your suggestions for how you can make improvements
in Cultural Awareness?

Managing Performance

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You address poor performance sooner rather than later.
  1. You measure performance of goals and objectives.
  1. You continuously measures performance and provides feedback to employees regularly.
  1. I determine the Objectives and Key Results (OKRs) needed for the position.
  1. I plan and set work expectations.
What are your suggestions for how you can make improvements
in Managing Performance?

Creativity

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You are able to create innovative products even when under specific constraints and requirements.
  1. You leverage interdepartmental connections to fuel creative solutions.
  1. I see learning as the engine of creativity, fueling fresh perspectives and novel ideas.
  1. You ask others to create new solutions to existing problems.
  1. You collaborate across teams to generate fresh ideas.
What are your suggestions for how you can make improvements
in Creativity?

Feedback

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You guide employees through a structured process of reflection and action planning.
  1. I actively seek contributions from diverse sources to ensure all voices are value and different viewpoints are incorporated.
  1. You build an atmosphere that fosters open communication, mutual respect, and perpetual growth to enable effective feedback exchange between managers and their teams.
  1. I work with human resources to implement training for the feedback system.
  1. I am willing to listen and consider feedback from colleagues, supervisors, and other stakeholders.
What are your suggestions for how you can make improvements
in Feedback?

Attitude

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You enjoy working for [Company]
  1. I bounce back quickly from setbacks.
  1. I accommodate differing work styles and needs when planning team interactions.
  1. I participate in planning and facilitating team-building activities or staff recognition events.
  1. I demonstrate care and thoughtfulness in even the smallest tasks.
What are your suggestions for how you can make improvements
in Attitude?

Decision Making

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. I use simulations, role-playing, or scenario planning to explore outcomes before committing to a course of action.
  1. I know when to delegate, collaborate, or pause based on an assessment of my capabilities or expertise.
  1. You openly admit when a choice didn't work out and use it as a learning opportunity without becoming defensive.
  1. I identify which factors can be adjusted and which must remain constant to guide viable decision paths.
  1. You determine the constraints that may impact what decisions are acceptable.
What are your suggestions for how you can make improvements
in Decision Making?

Innovation

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You look for opportunities to apply new and evolving technologies.
  1. You help focus the department on innovation.
  1. I leverage disruptive innovation to enhance simplicity and convenience, meeting the changing needs of their customers.
  1. You challenge assumptions about the way things work.
  1. I discover alternative methods for production.
What are your suggestions for how you can make improvements
in Innovation?

Achievement

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You are flexible in adjusting priorities to meet the demands of changing situations.
  1. You keep moving forward and stay focused on objectives despite setbacks.
  1. I commit to methodical execution, ensuring accountability and sustainable progress toward objectives.
  1. I implement standardized processes and procedures to help others achieve success.
  1. You allocate resources as needed to accomplish organizational goals.
What are your suggestions for how you can make improvements
in Achievement?

Clarity

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You check details thoroughly.
  1. You use appropriate grammar and tense in communications.
  1. You clearly explains responsibilities to individuals.
  1. You clearly explain the vision and goals of the company.
  1. You write clear job descriptions for positions in the organization.
What are your suggestions for how you can make improvements
in Clarity?

Customer Focus

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You consistently model positive customer service attitudes.
  1. You identify the most pressing needs of each customer.
  1. You encourage others to adopt a customer-first mindset through actions.
  1. You help customers to feel satisfied with our work/services.
  1. You prioritize customer issues to tackle the most pressing needs first.
What are your suggestions for how you can make improvements
in Customer Focus?

Recognition

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You express genuine appreciation for the work of others.
  1. You give recognition and appreciation fairly.
  1. You compliment other people when they do good work
  1. You offer recognition that reflect the employee's personal values, aspirations, and contributions in a way that feel authentic.
  1. I view recognition as a powerful motivator.
What are your suggestions for how you can make improvements
in Recognition?

Business Acumen

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You understand the costs, profits, markets, and added value of issues.
  1. I know how to use financial information to make an impact on the organization.
  1. I collect valuable customer insights to ensure our services meet their needs.
  1. I facilitate creativity and innovation in individuals by helping them understand different aspects of the business.
  1. You create unique strategies that impact the Company.
What are your suggestions for how you can make improvements
in Business Acumen?


  1. Strengths


  2. Areas for Development


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