Cultural Awareness - 360 Degree Feedback Survey Sample #8

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)

You have been selected to provide feedback for the manager listed above. Your feedback is an important part of 's leadership development process. This tool is intended to gather broad feedback in the core competencies and role responsibilities that are important for the on-going success of our organization.

In responding to the assessment form, please think about your experiences working with this individual during the last six to twelve months. Your responses will be merged with other people's feedback and presented to to guide them in their on-going development. Comments will be shared anonymously, as written, with the manager.

Sample Result Document:
Sample Results
Method of use: As part of the review process, managers will receive feedback from peers and staff. It is recognized that not all participants will be able to assess an individual's performance in all areas. The feedback received will be utilized as input to the manager's performance and on-going development plan.

You may sign out at any time by pressing the Save button at the end of the form and then closing your browser. You may return later to pick up where you left off. When you are done, press the Complete button.

When clicking your selection below, try to best fit the manager's actual behaviors to the scale provided.

If you are not sure, or unable to assess, select "Not Applicable" (N/A) option.

Please complete your response by .

Cultural Awareness

Agree Unsure Disagree N/A
  1. Seeks out different viewpoints and benefits from different perspectives.
  1. Respects others regardless of age, race, gender, nationality, or disability.
  1. Maintains an inclusive work environment that maximizes the talents of others in achieving goals.
  1. Shows respect in daily interactions
  1. Recognizes and values individual and cultural differences.


Agree Unsure Disagree N/A
  1. Willing to try new ideas.
  1. Works effectively during periods of change.
  1. Acts decisively in frequently changing and uncertain environment.
  1. Encourages others to adopt new procedures.
  1. Adapts to new organizational structures, policies, or procedures.

Bias for Action

Agree Unsure Disagree N/A
  1. Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).
  1. Displays high energy and enthusiasm on consistent basis.
  1. Conveys a sense of urgency about addressing problems and opportunities
  1. Coach others to foster an environment which can adapt quickly and willingly to rapid change.
  1. Identifies ways to simplify work processes and reduce cycle times

Continual Improvement

Agree Unsure Disagree N/A
  1. Looks for ways to improve work processes and procedures.
  1. Promotes training and development opportunities to enhance job performance.
  1. Open to the suggestions from others.
  1. Encourages an employee culture of continuous improvement to seek out better ways of doing things.
  1. Searches for new methods, techniques, and processes that increase efficiency and reduce costs.


Agree Unsure Disagree N/A
  1. Avoids making personal phone calls during working hours.
  1. Arrives to meetings on time.
  1. Maintains an efficient schedule of activities.
  1. Responds to requests for information in a timely manner.
  1. Starts the workday when scheduled.


Agree Unsure Disagree N/A
  1. Builds upon the ideas and solutions of others.
  1. Searches for opportunities and innovative ways to improve the organization.
  1. Takes risks to advance important ideas.
  1. Develops new products and services.
  1. Analyzes current procedures and identifies opportunities for improvement.

Time Management

Agree Unsure Disagree N/A
  1. Completes high-priority work within required timelines.
  1. Does not become flustered by deadlines and timelines.
  1. Sets clearly defined goals.
  1. Avoids distractions in the workplace.
  1. Completes tasks ahead of schedule.

Commitment To Result

Agree Unsure Disagree N/A
  1. Willing to do whatever it takes-not afraid to have to put in extra effort.
  1. Able to focus on a task even when working alone.
  1. Encourages commitment in others to obtain results.
  1. Coordinates all department activities into a cohesive team effort.
  1. Creates a sense of urgency among the store team members to complete activities, which drive sales.


Agree Unsure Disagree N/A
  1. Effectively organizes resources and plans
  1. Consistently provides me with timely feedback for improving my performance.
  1. Encourages me to take on greater responsibility.
  1. Able to organize work.
  1. Communicates goals and objectives to employees.

Client Focus

Agree Unsure Disagree N/A
  1. Satisfies client needs.
  1. Maintains strong relationships with clients.
  1. Is pro-active in dealing with clients and addressing their needs.
  1. Ensures client commitments and requirements are met or exceeded
  1. Forms strong client relationships


Agree Unsure Disagree N/A
  1. Develops the skills and capabilities of others.
  1. Helps employees to maintain high personal standards.
  1. Conducts regular performance appraisals and feedback.
  1. Provides clear, motivating, and constructive feedback.
  1. Addresses employee behavior problems effectively.


Agree Unsure Disagree N/A
  1. Follows existing procedures and processes.
  1. Understands the use of [Company] products and services.
  1. Attends [Company] gatherings and social events.
  1. Expresses loyalty and dedication to [Company] in interactions with others.
  1. Impresses upon others the important aspects of [Company].

  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.