Cultural Awareness - 360 Degree Feedback Survey Sample #4

Dear Employee:


Welcome to our 360-Degree Feedback Assessment of [Participant Name]. Our objective is to provide feedback which will help advance his/her leadership skills and capabilities. We are asking you to take time to respond to this survey to help us identify where we are doing well and where we have opportunities to do better.

We have developed this survey with questions tailored for [Participant Name]'s position in the department to provide you with an opportunity to anonymously rate many facets of his/her leadership performance. The survey will assess what you value most in their leadership skills and allow you to make positive suggestions for improvement.

Please be honest, constructive and thoughtful in your responses. The results of this survey will be used to help drive our future success. If you have any questions about the process please contact [Contact Person].

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



Instructions:
Please complete the items below and press the submit button at the end of the survey. If you need multiple sessions to complete the survey, please click the "Submit" button at the end of each session to save your responses. Please feel free to skip any items that you do not wish to respond to. Keep in mind that your responses help us to become a better place to work. So, you are encouraged to respond to all items on the questionnaire.

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Cultural Awareness	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Seeks opportunities to learn about the other cultural backgrounds of colleagues.
Understands how their own cultural background can impact the way they communicate and interact with others.
Seeks out different viewpoints and benefits from different perspectives.
Fosters a diverse workforce free from discrimination and harassment.
Understands how implicit biases can affect decisions, communication and productivity.
Supervisory Skills	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Considers diverse perspectives during the disciplinary process.
Is able to manage emotions during difficult times.
Has a strong work ethic that inspires others.
Has a high degree of multi-cultural competence to supervise individuals of various cultural backgrounds.
Maintains professional interactions with peers, customers, and employees.
Accountability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Regularly completes tasks on time.
Continues to work diligently on a problem despite setbacks.
Fully embraces the responsibilities that contribute to our departmental success.
Accepts accountability for their actions and results.
Holds team accountable to meeting goals.
Integrity	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Fosters a high standard of ethics and integrity.
Does what was promised.
Demonstrates honesty and truthfulness at all times.
Fosters an environment built upon trust.
Develops trust and confidence from others.
Continual Learning	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Builds on their strengths while addressing their weaknesses.
Views setbacks as opportunities to learn from.
Pursues learning that will enhance job performance.
Pursues professional development opportunities when they arise.
Improves on their skill sets.
Performance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Able to organize work.
Works effectively in the department.
Works well in this position.
...Overall Performance
...Produce Quality
Administrative Skill	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Takes responsibility for decisions.
Strong organizational skills to keep the workspace and department in order
Enthusiastic about taking on challenging projects.
High attention to detail.
Completes reports on-time.
Problem Solving	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Able to solve problems that involve political biases, conflicting evidence, and/or lack of data.
Implements actions as planned to address the problems.
Ensures that team members have the necessary training and are informed about best practices and procedures.
Acknowledges the unique viewpoints and perspectives of other team members to lead to more innovative and comprehensive solutions.
Establish clear, measurable goals that the action plan aims to achieve.
Co-worker Development	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Gives others development opportunities through project assignments and increased job responsibilities
Takes immediate action on poor performance
Adapts coaching and mentoring approach to meet the style or needs of individuals
Provides ongoing feedback to co-workers on their development progress
Sets and clearly communicates expectations, performance goals, and measurements to others
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Seeks opportunities to meet with others.
Supports strategic alliances to combine strengths of both parties.
Forms strong relationships with customers.
Engages in cross-functional activities by collaborating across boundaries.
Communicates with others in an open manner.
Teamwork	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Makes eye contact when listening to colleagues.
Actively participates as a team member
Encourages teamwork and collaboration.
Lets team members know when they have done well.
Is able to accurately paraphrase and summarize what other team members have said.
Planning	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Anticipates obstacles and ways to overcome them.
Is able to clearly articulate the plan for the department/district.
Develops plans to ensure the smooth operation of the supply chain.
Plans for future staffing needs.
Creates plans to handle complex, multi-faceted projects.

61. On a scale of Excellent to Poor, how would you rate your overall employment with [Company] and why?
    

    -Excellent -Good -Average -Poor




62. Would you refer others who are seeking employment to [Company]?
    Yes No
    
    Please provide explanation:
    
    
    
63. If you had an opportunity to make any change you wanted to make [Company] a better place to work, what one improvement would you make?
    
    
    
64. What changes do you see [Company] making in order to raise the standards?
    
    
    
65. I feel good about my continued employment with [Company].
    Yes No
    
    If no, please provide explanation:
    
    
    
66. What do you like best about working for [Company]?
    
    
    
67. What do you like least about working for [Company]? How could it be improved?
    
    
    
93. Use the space below to enter any final comments you would like to be noted: