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 value the diverse perspectives from others.
You understand how implicit biases can affect decisions, communication and productivity.
I participate in cultural training sessions/classes.
You avoid referring to stereotypes about others from different cultures.
You are curious and willing to ask questions about the cultural differences in the workplace.
Innovation	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You build upon the ideas and solutions of others.
You implement best practices within the department.
You foster a creative and innovative work environment.
You solve problems with insight and understanding.
You find creative ways to get things done with limited resources.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You demonstrate the functional or technical skills necessary to do your job.
You take a lot of pride in your work.
You demonstrate the analytical skills to do your job.
You are planful and organized.
You produce high quality work.
Client Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
I fulfill commitments made to clients.
You satisfy client needs.
You get feedback from the client on a weekly basis.
You are aware of what the client wants to receive.
You anticipate potential obstacles to meeting client needs.
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You readily share credit and gives others opportunity for visibility.
You are sincerely interested in the suggestions of co-workers
You make people around them feel appreciated and valued.
You offer recognition in a timely manner.
You recognize team members who offer a significant contribution to a project.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You understand the use of [Company] products and services.
You understand how decisions impact other business units beyond your immediate department of work group.
You follow existing procedures and processes.
You express loyalty and dedication to [Company] in interactions with others.
You understand the "basics" as to how [Company] functions/operates.
Fiscal Management	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You develop budgets and plans for various programs and initiatives.
You develop of the department's annual budget.
You ensure others follow the correct rules and regulations on fiscal matters.
You effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
You keep excellent records for financial transparency.
Global Perspective	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You volunteer for experiences and assignments abroad.
You understand how cultures differ and how these differences impact work behavior.
You cooperate with others on a global scale.
You work well with others from different cultural backgrounds.
You engage in problem solving with individuals outside of the country.

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.