Cultural Awareness - 360 Degree Feedback Survey Sample #11

360 Feedback Survey

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)

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 ...
  • You encourage a work environment where individual differences are valued.
  • You respect others regardless of age, race, gender, nationality, or disability.
  • You recognize and value individual and cultural differences.
  • You treat others with dignity and respect.
  • You foster a diverse workforce free from discrimination and harassment.

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


What does Creativity mean?
It means that ...
  • You inspire creativity in your team.
  • You conceive, implement and evaluate ideas.
  • You add value to the department/organization.
  • You develop solutions to challenging problems.
  • You are creative.

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


What does Feedback mean?
It means that ...
  • You consider other's opinion and suggestions.
  • You share past experiences with others as learning opportunities.
  • You accept the views of others.
  • You seek feedback to enhance performance.
  • You are easy to approach with ideas and opinions.

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

Administrative Skill

What does Administrative Skill mean?
It means that ...
  • You have a high attention to detail.
  • You are enthusiastic about taking on challenging projects.
  • You are able to develop, justify and present a budget.
  • You take responsibility for decisions.
  • You have strong technical/computer skills.

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


What does Teamwork mean?
It means that ...
  • You are an effective team player
  • You contribute to and supports team decision-making process
  • You build consensus and share relevant information.
  • You apply knowledge of team behavior to help achieve organizational goals and objectives.
  • You carry your share of the workload

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

Areas for Development

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