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

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Cultural Awareness	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You encourage a work environment where individual differences are valued.
You are open to learning about different cultures.
You are willing to work with employees who have different cultural backgrounds.
You respect others regardless of age, race, gender, nationality, or disability.
You respect the views offered by individuals with different cultural backgrounds.
Innovation	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You suggest ways to improve processes and systems.
You challenge assumptions about the way things work.
I encourage a diverse range of ideas and perspectives to cultivate an environment where innovation thrives.
I establish priorities and allocates resources to support innovation.
You seek innovative ways to change, grow, and improve the department.
Excellence	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You produce high quality work.
You keep yourself and others focused on constant improvement.
You can be counted on to add value wherever you are involved.
You demonstrate the analytical skills to do your job.
You are planful and organized.
Client Focus	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You understand the needs of the client.
I provide a responsive service that meets the needs of clients.
I make sure team members understand the issues faced by the client.
You provide a high level of service to clients.
I consistently meet client's needs.
Recognition	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You let employees know when they have done well
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 individuals for a specific outstanding achievement.
Company	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You understand the use of [Company] products and services.
You impress upon others the important aspects of [Company].
You understand the "basics" as to how [Company] functions/operates.
You attend [Company] gatherings and social events.
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 provide budgeting and accounting support to the Company.
You develop of the department's annual budget.
You ensure others follow the correct rules and regulations on fiscal matters.
You monitor spending.
You monitor expenses and verify the need for items purchased.
Global Perspective	Role Model	Capable and Effective	Somewhat Effective	Needs Development
You are comfortable using teleconferencing equipment to facilitate meetings with others abroad.
You demonstrate working knowledge of global transactions.
You work well with others from different cultural backgrounds.
You are able to listen and understand others and discuss issues in a respectful way.
You are able to work with individuals having different backgrounds and cultures.

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.