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. Encourages a work environment where individual differences are valued.
  1. Is aware of differences in how individuals from other cultures greet one another.
  1. Communicates with others without the influence of racism.
  1. Aware of their own cultural views.
  1. Maintains an inclusive work environment that maximizes the talents of others in achieving goals.


Agree Unsure Disagree N/A
  1. Can handle changes without complaining.
  1. Open to the perspectives/viewpoints of others.
  1. Implements changes as a result of having listened to employees
  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. Identifies ways to simplify work processes and reduce cycle times
  1. Conveys a sense of urgency about addressing problems and opportunities
  1. Completes work on time
  1. Completes a large volume of work.

Continual Improvement

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


Agree Unsure Disagree N/A
  1. Arrives to meetings on time.
  1. Starts the workday when scheduled.
  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. Finds creative ways to get things done with limited resources.
  1. Challenges current procedures to develop other alternatives.
  1. Builds upon the ideas and solutions of others.
  1. Searches for opportunities and innovative ways to improve the organization.
  1. Encourages open communication to ensure that all proposals are considered.

Time Management

Agree Unsure Disagree N/A
  1. Focuses on tasks that have high priority.
  1. Sets clearly defined goals.
  1. Completes high-priority work within required timelines.
  1. Avoids distractions in the workplace.
  1. Sets a good balance between work and family life.

Commitment To Result

Agree Unsure Disagree N/A
  1. Able to focus on a task even when working alone.
  1. Creates a sense of urgency among the store team members to complete activities, which drive sales.
  1. Willing to do whatever it takes-not afraid to have to put in extra effort.
  1. Committed to the team.
  1. Maintains persistence and dedication to achieving results.


Agree Unsure Disagree N/A
  1. Organizes and schedules events, activities, and resources.
  1. Establishes goals and objectives.
  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.

Client Focus

Agree Unsure Disagree N/A
  1. Anticipates and proactively resolves issues that the client may face.
  1. Meets with clients on a regular basis.
  1. Ensures clients are comfortable with the services provided.
  1. Keeps the client informed of all progress.
  1. Creates innovative solutions to meet client needs.


Agree Unsure Disagree N/A
  1. Helps employees to maintain high personal standards.
  1. Conducts regular performance appraisals and feedback.
  1. Addresses employee behavior problems effectively.
  1. Develops the skills and capabilities of others.
  1. Coaches employees in how to strengthen knowledge and skills to improve work performance.


Agree Unsure Disagree N/A
  1. Follows existing procedures and processes.
  1. Understands the use of [Company] products and services.
  1. Impresses upon others the important aspects of [Company].
  1. Understands the "basics" as to how [Company] functions/operates.
  1. Understands how decisions impact other business units beyond their immediate department of work group.

  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.