Cultural Awareness - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

Instructions

We appreciate you taking the time to provide valuable feedback for the individual mentioned above. As you respond, please draw on your first-hand experience with this individual in the past 12 months. Your insights are crucial in offering a comprehensive evaluation. Please rate each item using the scale provided. If you find that you do not have sufficient first-hand knowledge to rate a particular item, select the Not Applicable option.

In addition to the ratings, we encourage you to include comments where possible. These comments are particularly useful when you give a very high or very low rating, as they provide context and clarity regarding your assessment. Explaining your reasons in the comment section helps ensure that your feedback is constructive and actionable.

Your responses, combined with feedback from other contributors, will be compiled and presented to the individual. This collective feedback aims to support their continuous growth and development by highlighting strengths and identifying areas for improvement. Your thoughtful participation is essential in helping them achieve their full potential.

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.

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Cultural Awareness

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

• I seek clarification to avoid misunderstandings.
• I help other employees to become more culturally sensitive.
• I am effective in working with individuals with a variety of cultural backgrounds.
• You foster a diverse workforce free from discrimination and harassment.
• You understand how implicit biases can affect decisions, communication and productivity.

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 create a lot of new ideas.
• You develop solutions to challenging problems.
• You add value to the department/organization.
• You are creative and inspirational.
• You are creative.

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 actively seek feedback from others.
• You ask others for their ideas and opinions.
• You look to others for input.
• You are open to the suggestions of others.
• You are visible and approachable.

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 are enthusiastic about taking on challenging projects.
• You accurately implement contract provisions.
• You have a high attention to detail.
• You complete reports on-time.
• You have strong technical/computer skills.

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 ...

• I listen carefully to other team members.
• I make decisions that support the team's goals and objectives.
• You let team members know when they have done well.
• You build relationships across boundaries and with key stakeholders by developing informal and formal networks.
• You foster teamwork rather than individual competition

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.