Cultural Awareness - 360 Degree Feedback Survey Sample #5

360-Degree Assessment Survey

Dear Employee:

Thank you for participating in a 360-degree feedback assessment. In this process, you will complete a self-assessment questionnaire (below). You will also receive feedback from others including your manager, peers and direct reports. As you respond, please respond using just your experiences in the past 12 months. Rate each item using the scale shown. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the Closing Comments section. Your responses will be compiled with feedback from others and presented to you at the conclusion of this assessment to help guide your ongoing professional development.

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 by .

Thank you for your participation in the survey.

Management Team

Cultural Awareness	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You avoid referring to stereotypes about others from different cultures.
You understand the impact that your culture may have on interactions between individuals.
I recognize individual and cultural differences.
You respect others regardless of age, race, gender, nationality, or disability.
I seek opportunities to learn about the other cultural backgrounds of colleagues.
Innovation	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You find creative ways to get things done with limited resources.
You search for opportunities and innovative ways to improve the organization.
You challenge current procedures to develop other alternatives.
You offer constructive improvements to existing systems.
You build upon the ideas and solutions of others.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You can be counted on to add value wherever you are involved.
You keep yourself and others focused on constant improvement.
You are planful and organized.
You demonstrate the functional or technical skills necessary to do your job.
You take a lot of pride in your work.
Client Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You adapt to changing client needs.
You use client feedback to help improve products and services.
You are pro-active in dealing with clients and addressing your needs.
You ensure clients are comfortable with the services provided.
I provide a responsive service that meets the needs of clients.
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You recognize individuals for a specific outstanding achievement.
You say "thank you" to show appreciation for work of others.
You recognize the abilities and skills of self and others
You are sincerely interested in the suggestions of co-workers
You recognize team members who offer a significant contribution to a project.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You follow existing procedures and processes.
You understand the "basics" as to how [Company] functions/operates.
You express loyalty and dedication to [Company] in interactions with others.
You understand the use of [Company] products and services.
You understand how decisions impact other business units beyond your immediate department of work group.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You keep excellent records for financial transparency.
You are effective in using company's resources.
You monitor expenses and verify the need for items purchased.
You ensure others follow the correct rules and regulations on fiscal matters.
You develop of the department's annual budget.
Global Perspective	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are able to listen and understand others and discuss issues in a respectful way.
You consider customers point of view when making decisions.
You engage in problem solving with individuals outside of the country.
You build working relationships with others across cultures.
You develop both the cultural awareness and business skills to grow our business in all countries, and work effectively across borders with employees, customers, and shareowners.

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

    5- Very Effective 4- Effective 3- Neither 2- Ineffective 1- Very Ineffective

    
    
42. Strengths
    
    
    
43. Areas for Development
    
    
    
44. Please give any final comments or suggestions for [Participant Name Here]'s assessment.