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 foster a diverse workforce free from discrimination and harassment.
You recognize and value individual and cultural differences.
You seek out different viewpoints and benefits from different perspectives.
You encourage a work environment where individual differences are valued.
You value the opinions of diverse groups and individual.
Innovation	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You foster a creative and innovative work environment.
You take risks to advance important ideas.
You build upon the ideas and solutions of others.
You find creative ways to get things done with limited resources.
You offer constructive improvements to existing systems.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You keep yourself and others focused on constant improvement.
You produce high quality work.
You demonstrate the analytical skills to do your job.
You demonstrate the functional or technical skills necessary to do your job.
You are planful and organized.
Client Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You obtain feedback to ensure client needs are being met.
You form strong client relationships
You ensure client commitments and requirements are met or exceeded
You look for opportunities that have a positive impact on Clients.
You maintain strong relationships with clients.
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You readily share credit and gives others opportunity for visibility.
You say "thank you" to show appreciation for work of others.
You reinforce and reward employees for accomplishing necessary goals.
You recognize the abilities and skills of self and others
You let employees know when they have done well
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You understand the use of [Company] products and services.
You express loyalty and dedication to [Company] in interactions with others.
You attend [Company] gatherings and social events.
You impress upon others the important aspects of [Company].
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 monitor expenses and verify the need for items purchased.
You develop budgets and plans for various programs and initiatives.
You keep excellent records for financial transparency.
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 facilitate open communication with individuals from other countries.
You engage in problem solving with individuals outside of the country.
You are able to work with others from different cultures and countries.
You form strong client relationships with international partners.
You are aware of the culture, behaviors, identities and beliefs of others.

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.