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)
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.


Cultural Awareness

Clear
Strength
Capable
and
Effective
Could
Benefit from
Development
Needs
Significant
Improvement
  1. You respect others regardless of age, race, gender, nationality, or disability.
  1. I am effective in working with individuals with a variety of cultural backgrounds.
  1. I value the diverse perspectives from others.
  1. I am aware of cultural differences in business etiquette.
  1. I interact effectively with people from different cultural backgrounds.
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 give additional responsibilities to individuals who exceed standards.
  1. You set clear and ambitious goals to be met.
  1. I measure performance using standard production quotas.
  1. I ensure the employee understands the key tasks, goals and KPIs required for the position.
  1. I recognize people who provide outstanding leadership in planning, organizing.
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 develop solutions to challenging problems.
  1. You conceive, implement and evaluate ideas.
  1. You inspire creativity in your team.
  1. You are creative and inspirational.
  1. You are creative.
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 actively seek feedback from others.
  1. You are easy to approach with ideas and opinions.
  1. You look to others for input.
  1. You ask others for their ideas and opinions.
  1. You are visible and approachable.
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 are gracious and professional in your interactions with others.
  1. You contribute to a positive and fun work environment.
  1. You visibly support and encourages diversity in style and background.
  1. You work to eliminate unnecessary work or barriers that get in others' way.
  1. You treat all people fairly and with respect.
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. You outline the parameters influencing the decision making process.
  1. I facilitate meetings with others to try to consider alternative courses of action.
  1. I make good decisions for the Department.
  1. You understand factors are important for deciding if a decision is "worth it"?
  1. I am open to listening to others who may have different ideas.
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 implement best practices within the department.
  1. You develop new products and services.
  1. You encourage open communication to ensure that all proposals are considered.
  1. You find creative ways to get things done with limited resources.
  1. You analyze current procedures and identify opportunities for improvement.
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. I work to meet required benchmarks for the position.
  1. You work at a quick pace to complete a high volume of work.
  1. You set high standards in your performance
  1. You make use of talents of others to help achieve a high level of performance.
  1. You are flexible in adjusting priorities to meet the demands of changing situations.
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 avoid stating unclear or conflicting goals.
  1. You communicate ideas and facts clearly and effectively in writing.
  1. You clearly explains responsibilities to individuals.
  1. You communicate with clarity and efficiency.
  1. You provide a clear vision for the future.
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. I am aware of expectations from customers.
  1. I build products that meet the unique needs of each customer.
  1. I am consistent in services provided to customers.
  1. You manage customer accounts with high degree of competence.
  1. You deliver high quality products to the customer.
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 reinforce and reward employees for accomplishing necessary goals.
  1. You recognize team members who offer a significant contribution to a project.
  1. You let employees know when they have done well
  1. You say "thank you" to show appreciation for work of others.
  1. You compliment other people when they do good work
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. I establish clear, long-term objectives that align with the company's vision and mission.
  1. I understand consumer behaviors and how they may change in the future.
  1. I establish key performance indicators (KPIs) to measure progress and success.
  1. You view problems from a business perspective, opportunity, investment, risks, and anticipated results
  1. You are able to correctly assess current/estimated valuations.
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.