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)

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.

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. Values the opinions of diverse groups and individual.
  1. Seeks out different viewpoints and benefits from different perspectives.
  1. Fosters a diverse workforce free from discrimination and harassment.
  1. Recognizes and values individual and cultural differences.
  1. Encourages a work environment where individual differences are valued.


Agree Unsure Disagree N/A
  1. Willing to try new ideas.
  1. Able to adapt to new situations.
  1. Implements changes as a result of having listened to employees
  1. Adapts to circumstances as needed.
  1. Encourages others to adopt new procedures.

Bias for Action

Agree Unsure Disagree N/A
  1. Completes a large volume of work.
  1. Identifies ways to simplify work processes and reduce cycle times
  1. Motivates others to achieve or exceed goals
  1. Encourages risk taking and experimentation to improve performance
  1. Projects a "can-do" attitude when interfacing with peers, subordinates and customers(especially during difficult and challenging times).

Continual Improvement

Agree Unsure Disagree N/A
  1. Promotes training and development opportunities to enhance job performance.
  1. Open to the suggestions from others.
  1. Looks for ways to expand and learn new job skills.
  1. Looks for ways to expand current job responsibilities.
  1. Looks for ways to improve work processes and procedures.


Agree Unsure Disagree N/A
  1. Arrives to meetings on time.
  1. Avoids making personal phone calls during working hours.
  1. Starts meetings on time.
  1. Maintains an efficient schedule of activities.
  1. Invoices clients on a timely basis.


Agree Unsure Disagree N/A
  1. Offers constructive improvements to existing systems.
  1. Challenges current procedures to develop other alternatives.
  1. Suggests new ideas at meetings.
  1. Analyzes current procedures and identifies opportunities for improvement.
  1. Builds upon the ideas and solutions of others.

Time Management

Agree Unsure Disagree N/A
  1. Prioritizes new tasks according to their relative importance.
  1. Leaves time in the schedule for unplanned contingencies.
  1. Prioritizes tasks to identify immediate and long-term objectives.
  1. Focuses on tasks that have high priority.
  1. Keeps and maintains a To-Do list.

Commitment To Result

Agree Unsure Disagree N/A
  1. Encourages commitment in others to obtain results.
  1. Creates a sense of urgency among the store team members to complete activities, which drive sales.
  1. Coordinates all department activities into a cohesive team effort.
  1. Maintains persistence and dedication to achieving results.
  1. Conveys strong sense of own pride in Company to associates by creating a shared vision around sales and customer service.


Agree Unsure Disagree N/A
  1. Ability to establish realistic goals.
  1. Consistently provides me with timely feedback for improving my performance.
  1. Organizes and schedules events, activities, and resources.
  1. Able to organize work.
  1. Sets long-term and short-term goals.

Client Focus

Agree Unsure Disagree N/A
  1. Forms strong client relationships
  1. Satisfies client needs.
  1. Looks for opportunities that have a positive impact on Clients.
  1. Ensures client commitments and requirements are met or exceeded
  1. Is pro-active in dealing with clients and addressing their needs.


Agree Unsure Disagree N/A
  1. Meets regularly with employees to coach them on areas that will enhance their performance
  1. Helps employees to understand responsibilities, authority, and expectations.
  1. Addresses employee behavior problems effectively.
  1. Develops the skills and capabilities of others.
  1. Conducts regular performance appraisals and feedback.


Agree Unsure Disagree N/A
  1. Expresses loyalty and dedication to [Company] in interactions with others.
  1. Follows existing procedures and processes.
  1. Attends [Company] gatherings and social events.
  1. Impresses upon others the important aspects of [Company].
  1. Understands the "basics" as to how [Company] functions/operates.

  1. Overall, please rate the effectiveness of .

  2. Strengths

  3. Areas for Development

  4. Please give any final comments or suggestions for 's assessment.