Cultural Awareness - 360 Degree Feedback Survey Sample #3





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

You have been asked to evaluate yourself as part of a 360-degree feedback process. Other employees, including your manager(s), peers, and direct reports will also evaluate you. In this manner, you will be provided with a comprehensive, multi-perspective (i.e., 360-degree) view of your performance as a manager. The objective is to provide you with feedback so as to allow you to improve your performance, resulting in improved team performance, and organizational effectiveness.

If you are not able to respond to an item, leave it blank and go on to the next item.

Sample Result Document:
Sample Results
We encourage everyone to complete the survey. Please be honest, constructive and thoughtful in your input. The survey is designed to help us understand more about your thoughts and needs to make this a great company.

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





Cultural Awareness

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Encourages a work environment where individual differences are valued.
  1. Communicates with others without the influence of racism.
  1. Views diversity as a strength, not as an issue.
  1. Engages with individuals that have different cultural backgrounds.
  1. Values the diverse perspectives from others.
Please feel free to provide any comments to help explain your answers?

Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Makes you feel enthusiastic about your work
  1. Delegate tasks effectively
  1. Takes responsibility for things that go wrong
  1. Is ready to offer help
  1. Sets an example for others to follow
Please feel free to provide any comments to help explain your answers?

Communication Skills

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Coaches others and provides feedback on the use of different oral communication styles for different audiences
  1. Writes complete and developmentally-oriented performance appraisals with clear goals, using SMART criteria
  1. Communicates crucial information to others.
  1. Listens effectively and responds to new information.
  1. Can effectively deliver presentations.
Please feel free to provide any comments to help explain your answers?

Action

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Works quickly when faced with difficult problems.
  1. Seeks new opportunities for advancement.
  1. Addresses performance issues quickly.
  1. Anticipates critical incidents in the department and takes steps to mitigate their effect.
  1. Decides to act rather than remain passive.
Please feel free to provide any comments to help explain your answers?

Project Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Successfully negotiated contracts with suppliers.
  1. Initiates large projects.
  1. Accurately determines the number of engineers required for the project.
  1. Plans and implements responses to potential threats to the success of the project.
  1. Identifies risks to each phase of the project.
Please feel free to provide any comments to help explain your answers?

Problem Solving

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Solves problems using logic and insight.
  1. Ability to develop innovative solutions to problems.
  1. Implements effective solutions to critical problems.
  1. Finds creative ways to get things done with limited resources.
  1. Able to balance the needs of different people in a solution to a problem.
Please feel free to provide any comments to help explain your answers?

Technology Use/Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Maximizes the use of new technology to deliver products and services.
  1. Adopts the implementation of new technology into the workplace.
  1. Understands and is committed to implementing new technologies.
  1. Applies complex rules and regulations to maintain optimal system performance.
  1. Supports employee training and development initiatives regarding implementation of technology.
Please feel free to provide any comments to help explain your answers?

Interpersonal Skills

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Communicates initiatives in a clear and actionable manner to employees.
  1. Is thoughtful and honest about the feedback they give others.
  1. Is well respected in the department.
  1. Provides constructive feedback in a way that fosters acceptance and development.
  1. Attends to both the content and the context of what was being said.
Please feel free to provide any comments to help explain your answers?

Client Focus

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Actively listens to concerns from clients.
  1. Exhibits a positive attitude even when dealing with difficult clients.
  1. Tailors solutions to meet the specific needs of each client.
  1. Competent in managing client projects.
  1. Understands what resources are needed to meet client needs.
Please feel free to provide any comments to help explain your answers?

Conflict Management

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Addresses contentious issues earlier rather than later.
  1. Attempts to determine the root sources of grievances.
  1. Assists team members by helping them see the other point of view.
  1. Settles disputes with agreement from both parties.
  1. Seeks to achieve mutually acceptable outcomes.
Please feel free to provide any comments to help explain your answers?

Strategic Insight

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Strategically aligns projects to the goals of the company.
  1. Pursues strategic alliances with valued partners.
  1. Lets employees know how their roles contribute toward the achievement of strategic company objectives.
  1. Recognizes the needs of customers.
  1. Ensures that the department's goals are strategically aligned with the company's goals.
Please feel free to provide any comments to help explain your answers?

Global Perspective

Does Not
Exhibit this
Competency
Seldom
Exhibits this
Competency
Sometimes
Exhibits this
Competency
Usually
Exhibits this
Competency
Always
Exhibits this
Competency
  1. Facilitates open communication with individuals from other countries.
  1. Comfortable using teleconferencing equipment to facilitate meetings with others abroad.
  1. Works well with others from different cultural backgrounds.
  1. Volunteers for experiences and assignments abroad.
  1. Applies knowledge of overseas markets.
Please feel free to provide any comments to help explain your answers?

  1. Overall, please rate the effectiveness of [Participant Name].






  2. Strengths


  3. Areas for Development


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