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Cultural Awareness - 360 Degree Feedback Survey Sample #5





360-Degree Assessment Survey

Questionnaires Measuring Cultural Awareness:
Survey 1 (4-point scale; Competency Comments)
Survey 2 (4-point scale; Competency Comments)
Survey 3 (5-point scale; Competency Comments)
Survey 4 (5-point scale; radio buttons)
Survey 5 (4-point scale; words)
Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
Survey 8 (3-point scale; Agree/Disagree words; N/A)
Survey 9 (3-point scale; Strength/Development; N/A)
Survey 10 (Comment boxes only)
Survey 11 (Single rating per competency)
Survey 12 (Slide-bar scale)
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
  1. You respect others regardless of age, race, gender, nationality, or disability.
  1. You recognize and value individual and cultural differences.
  1. You encourage a work environment where individual differences are valued.
  1. You treat others with dignity and respect.
  1. You foster a diverse workforce free from discrimination and harassment.


Innovation

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. You implement best practices within the department.
  1. You create a safe environment for idea-sharing.
  1. You offer constructive improvements to existing systems.
  1. You analyze current procedures and identify opportunities for improvement.
  1. You build upon the ideas and solutions of others.


Excellence

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. You take a lot of pride in your work.
  1. You are planful and organized.
  1. You demonstrate the analytical skills to do your job.
  1. You keep yourself and others focused on constant improvement.
  1. You produce high quality work.


Client Focus

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. You satisfy client needs.
  1. You are pro-active in dealing with clients and addressing your needs.
  1. You look for opportunities that have a positive impact on Clients.
  1. You obtain feedback to ensure client needs are being met.
  1. You ensure client commitments and requirements are met or exceeded


Recognition

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. You offer recognition in a timely manner.
  1. You are sincerely interested in the suggestions of co-workers
  1. You reinforce and reward employees for accomplishing necessary goals.
  1. You say "thank you" to show appreciation for work of others.
  1. You let employees know when they have done well


Company

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. You impress upon others the important aspects of [Company].
  1. You express loyalty and dedication to [Company] in interactions with others.
  1. You attend [Company] gatherings and social events.
  1. You understand the use of [Company] products and services.
  1. 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
  1. You effectively manage appropriations, reporting, purchases, expenditures, payrolls, and staff.
  1. You monitor expenses and verify the need for items purchased.
  1. You are effective in using company's resources.
  1. You develop budgets and plans for various programs and initiatives.
  1. You monitor spending.


Global Perspective

Role
Model
Capable and
Effective
Somewhat
Effective
Needs
Development
  1. You align personal vision with global strategies.
  1. You apply knowledge of overseas markets.
  1. You demonstrate working knowledge of global transactions.
  1. You analyze global issues/problems that are having a large impact on the Company.
  1. You understand how cultures differ and how these differences impact work behavior.



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






  2. Strengths


  3. Areas for Development


  4. Please give any final comments or suggestions for [Participant Name Here]'s assessment.