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
Treats others with dignity and respect.
Shows respect in daily interactions
Respects others regardless of age, race, gender, nationality, or disability.
Encourages a work environment where individual differences are valued.
Seeks out different viewpoints and benefits from different perspectives.
Supervisory Skills	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Treats all staff equitably.
Is aware of the unique strengths of each employee.
Appropriately recognizes and rewards employees.
Resolves personnel problems quickly and effectively.
Maintains good working relationships with employees.
Accountability	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Can be counted on to do what they say they are going to do.
Keeps supervisor informed of recent events.
Defines roles, rights, and responsibilities of employees.
Implements and facilitates controls and processes that maintain the integrity of the organization.
Accepts accountability for their actions and results.
Integrity	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Fosters a high standard of ethics and integrity.
Accepts responsibility for mistakes.
Develops trust and confidence from others.
Demonstrates sincerity in actions with others.
Follows tasks to completion.
Continual Learning	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Grasps new ideas, concepts, technical, or business knowledge.
Participates in regular training offered.
Builds on their strengths while addressing their weaknesses.
Seeks opportunities to grow in skills and knowledge.
Takes the initiative to learn new skills.
Performance	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Sets a high standard for job performance.
Works well in this position.
Listens and responds to issues and problems
Effectively organizes resources and plans
...Produce Quality
Administrative Skill	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Accurately implements contract provisions.
Takes responsibility for decisions.
Enthusiastic about taking on challenging projects.
Strong organizational skills to keep the workspace and department in order
Has strong technical/computer skills.
Problem Solving	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Is a good problem solver and decision maker
Effective in solving problems.
Identifies and assesses all potential responses to a problem.
Ability to develop innovative solutions to problems.
Works cooperatively with others to solve problems.
Co-worker Development	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Takes immediate action on poor performance
Sets and clearly communicates expectations, performance goals, and measurements to others
Adapts coaching and mentoring approach to meet the style or needs of individuals
Works to identify root causes of performance problems
Provides ongoing feedback to co-workers on their development progress
Partnering/Networking	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Creates the conditions for partnerships to grow and develop.
Develops a sense of trust in subordinates so they can freely interact and share information with others.
Maintains infrastructure to support partnerships and networks.
Collaborates with others to accomplish goals and objectives.
Seeks an understanding of diverse functions within the Company.
Teamwork	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Encourages others to share ideas to develop team cohesion
Creates a culture that fosters and values collaboration.
Seeks and listens to other's contributions
Identifies and resolves conflicts within the team to increase team effectiveness
Facilitates team discussions and problem-solving
Planning	Needs Significant Development 1	2	Capable and Effective 3	4	Role Model 5
Works in an organized manner
Able to look ahead (beyond the present) when addressing the work/needs of the department.
Delegates role to team members to accomplish goals.
Anticipates obstacles and ways to overcome them.
Anticipates potential challenges, develops plan to overcome them and then carries out the plan.

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: