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
I recognize individual and cultural differences.
You foster a diverse workforce free from discrimination and harassment.
You recognize and value individual and cultural differences.
You understand the impact that your culture may have on interactions between individuals.
You understand how your own cultural background can impact the way you communicate and interact with others.
Innovation	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You develop new products and services.
You create a safe environment for idea-sharing.
You encourage open communication to ensure that all proposals are considered.
You create improved methods or solutions for meeting goals and objectives.
You foster a creative and innovative work environment.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You take a lot of pride in your work.
You can be counted on to add value wherever you are involved.
You demonstrate the analytical skills to do your job.
You demonstrate the functional or technical skills necessary to do your job.
You produce high quality work.
Client Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You treat clients with courtesy and respect.
I create new and innovative products for clients.
I am available to respond to client needs.
You create innovative solutions to meet client needs.
You create innovative solutions for the clients.
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You offer recognition in a timely manner.
You recognize the abilities and skills of self and others
You make people around them feel appreciated and valued.
You are sincerely interested in the suggestions of co-workers
You compliment other people when they do good work
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You attend [Company] gatherings and social events.
You understand how decisions impact other business units beyond your immediate department of work group.
You understand the use of [Company] products and services.
You impress upon others the important aspects of [Company].
You follow existing procedures and processes.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You provide budgeting and accounting support to the Company.
You effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
You monitor spending.
You are effective in using company's resources.
You ensure others follow the correct rules and regulations on fiscal matters.
Global Perspective	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You understand how cultures differ and how these differences impact work behavior.
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.
You create an environment where individual differences are valued and supported.
You facilitate open communication with individuals from other countries.
You are able to listen and understand others and discuss issues in a respectful way.

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.