Cultural Awareness - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

Instructions

Thank you for providing feedback for the recipient above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Rate each item using the scale shown. If you don't feel you have enough first-hand information to rate a certain item, please choose the Not Applicable option. Comments can be very helpful; at a minimum where you give a particularly high or low rating, please share your reasons in the comment section for that competency. Your responses will be compiled with feedback from others and presented to the recipient to help guide their ongoing 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.

To what extent does [Participant Name] exhibit the following ...

SELECT the rating that best reflects the employee's performance in the areas listed.

Cultural Awareness

What does Cultural Awareness mean?
It means that ...

• I seek opportunities to learn about the other cultural backgrounds of colleagues.
• You respect others regardless of age, race, gender, nationality, or disability.
• You acknowledge your own biases in cultural interactions.
• I am an advocate for others with different cultural backgrounds.
• I view diversity as a strength, not as an issue.

To what extent does this person exhibit Cultural Awareness?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Creativity

What does Creativity mean?
It means that ...

• You are creative.
• You conceive, implement and evaluate ideas.
• You are creative and inspirational.
• You develop solutions to challenging problems.
• You add value to the department/organization.

To what extent does this person exhibit Creativity?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Feedback

What does Feedback mean?
It means that ...

• You ask others for their ideas and opinions.
• You actively seek feedback from others.
• You share past experiences with others as learning opportunities.
• You consider other's opinion and suggestions.
• You are open to the suggestions of others.

To what extent does this person exhibit Feedback?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Administrative Skill

What does Administrative Skill mean?
It means that ...

• You have a high attention to detail.
• You have strong technical/computer skills.
• You have strong organizational skills to keep the workspace and department in order
• You complete reports on-time.
• You take responsibility for decisions.

To what extent does this person exhibit Administrative Skill?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Teamwork

What does Teamwork mean?
It means that ...

• You coach team members
• You willingly share your technical expertise
• You are open to new ideas that may change own goals for benefit of the team
• You coach team members to work toward a common goal.
• You actively participates in the work of teams; seek and listen to others' contributions

To what extent does this person exhibit Teamwork?
Select from one of the ratings below.

Not Applicable or Unable to Judge

Poor does not perform to expected standards; often unable to complete tasks; does not seek help or advice

Minimal completes tasks only when pressured to do so; is satisfied with minimal progress; only does what is required

Average completes tasks easily; seeks to obtain maximal performance; willing to seek advice and help when needed

Role Model is a role model for others to follow; goes above and beyond what is expected; helps others

Strengths


Areas for Development


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