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HR-Survey > 360-Degree Feedback > Competency Model > Cultural Awareness

Cultural Awareness - 360 Degree Feedback Survey Sample #2

October 30, 2025

Self-Assessment Instructions
Questionnaires Measuring Cultural
You have been asked to complete a self-assessment questionnaire Awareness:
form (shown below). You will also receive feedback from others such Survey 1 (4-point scale; Competency Comments)
as your peers, direct reports and manager. Feedback is an important Survey 2 (4-point scale; Competency Comments)
part of our company's leadership development process and this Survey 3 (5-point scale; Competency Comments)
survey is intended to gather broad feedback in the core Survey 4 (5-point scale; radio buttons)
competencies and role responsibilities that are important for the on- Survey 5 (4-point scale; words)
going success of our organization. Survey 6 (4-point scale; words)
Survey 7 (5-point scale; competency comments; N/A)
In responding to the questions below, think about your experiences Survey 8 (3-point scale; Agree/Disagree words; N/A)
as an employee over the last twelve months and the goals you were Survey 9 (3-point scale; Strength/Development; N/A)
asked to achieve. The effectiveness of this development tool is Survey 10 (Comment boxes only)
dependent on your honest, forthright and constructive responses so Survey 11 (Single rating per competency)
please bear this in mind as you answer each question. Your Survey 12 (Slide-bar scale)
responses will become part of the assessment process to foster your Survey 13 (4-point scale; numbers; floating anchors)
growth and on-going development. Survey 14 (4-point scale; N/A)

Competencies Included:
Cultural Awareness, Managing Performance, Creativity,
Feedback, Attitude, Decision Making, Innovation,
Achievement, Clarity, Customer Focus, Recognition,
Business Acumen

Partially completed forms can be saved by using the Save/Still

Working button at the bottom of the page. You may return at a Sample Result Document:
later time to complete/edit the form. Your saved responses will be Sample Results
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.

Please ensure that your submission is made between October 31 and November 13. The survey will only be available during these
dates.

Cultural Awareness Capable Could Needs

Clear and Benefit from Significant
Strength Effective Development Improvement

1. You actively listen to diverse viewpoints without judgment or

dismissal.

2. I recognize individual and cultural differences.

3. You are aware of the similarities and differences among and between
cultural groups.

4. I function effectively within various cultural contexts.

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 5. I promote continuous learning about customs, traditions, and
workplace etiquette.

What are your suggestions for how you can make improvements
in Cultural Awareness?

Managing Performance Capable Could Needs

Clear and Benefit from Significant
Strength Effective Development Improvement

6. You give additional responsibilities to individuals who exceed

standards.

7. You reward employees for exceeding goals.

8. I convey expectations for meeting performance metrics.

9. You effectively use the current performance review process.

10. I participate in training as needed to improve job performance.

What are your suggestions for how you can make improvements
in Managing Performance?

Creativity Capable Could Needs

Clear and Benefit from Significant
Strength Effective Development Improvement

11. I create feasible solutions to problems.

12. I create space for others to share creative input.

13. You transform learning into creative output.

14. I imagine new products, services, or process before they're needed.

15. I reflect on past outcomes to inform more creative future decisions.

What are your suggestions for how you can make improvements
in Creativity?

Feedback Capable Could Needs

Clear and Benefit from Significant
Strength Effective Development Improvement

16. You begin feedback with what the recipient is doing well to set a
positive tone and help them feel valued.

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 17. I develop a culture that support open conversations, mutual respect,
and continuous enhancement to facilitate constructive feedback
between managers and their employees.

18. You look to others for input.

19. I provide the necessary tools, training, and support to ensure that
feedback is constructive, timely, and actionable.

20. You allow the person providing feedback to complete their thoughts
without interrupt them.

What are your suggestions for how you can make improvements
in Feedback?

Attitude Capable Could Needs

Clear and Benefit from Significant
Strength Effective Development Improvement

21. You embrace unexpected challenges with a calm, solution-oriented

mindset.

22. I model adaptability and proactive engagement.

23. You frame smart risk-taking as the best approach to solving

problems.

24. I am willing to mentor and coach employees.

25. I bounce back quickly from setbacks.

What are your suggestions for how you can make improvements
in Attitude?

Decision Making Capable Could Needs

Clear and Benefit from Significant
Strength Effective Development Improvement

26. You outline the parameters influencing the decision making process.

27. I understand how my decisions will affect others.

28. You make decisions independently (without having to be told what

or how).

29. I facilitate meetings with others to try to consider alternative courses

of action.

30. You acknowledge how personal preferences or blind spots may skew
judgment and take steps to counteract them.

What are your suggestions for how you can make improvements
in Decision Making?
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 Innovation Capable Could Needs
Clear and Benefit from Significant
Strength Effective Development Improvement

31. I keep an open mind towards innovative concepts ensuring

managers are continuously exploring potential growth avenues.

32. You encourage others to experiment and learn from their mistakes
without fear of retribution.

33. I encourage employees to consider opportunities to innovate

processes and products.

34. I promote collaboration across different departments to combine

varied perspectives and expertise, which can spark innovative ideas.

35. I coordinate the activities of the innovation steering committee.

What are your suggestions for how you can make improvements
in Innovation?

Achievement Capable Could Needs

Clear and Benefit from Significant
Strength Effective Development Improvement

36. I take calculated risks to achieve significant rewards.

37. You demonstrate tenacity in completing tasks regardless of shift

circumstances.

38. You take immediate action of projects that fall behind schedule.

39. You define precise, structured objectives that helps the department
progress and holds employees accountable.

40. You are determined to complete tasks regardless of obstacles that

may occur.

What are your suggestions for how you can make improvements
in Achievement?

Clarity Capable Could Needs

Clear and Benefit from Significant
Strength Effective Development Improvement

41. You avoid creating ambiguity or mixed messages.

42. You use appropriate grammar and tense in communications.

43. You
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 44. You clarify problems and their causes to help employees correct
them.

45. You make sure goals and objectives are clearly and thoroughly
explained and understood.

What are your suggestions for how you can make improvements
in Clarity?

Customer Focus Capable Could Needs

Clear and Benefit from Significant
Strength Effective Development Improvement

46. I am committed to the customer's success.

47. You help raise the tone or energy of the team through positive
customer interactions.

48. I am committed to resolving customer issues in a positive way.

49. I take the initiative in solving difficult customer issues.

50. You prioritize the needs and preferences of the customer.

What are your suggestions for how you can make improvements
in Customer Focus?

Recognition Capable Could Needs

Clear and Benefit from Significant
Strength Effective Development Improvement

51. You match the reward to the person being recognized.

52. I recognize employees that participate on important teams.

53. You create awards or recognition for specific service anniversary

dates.

54. I offer a one-on-one acknowledgement of the success of the

employee.

55. I give spontaneous recognition in the proper context.

What are your suggestions for how you can make improvements
in Recognition?

Business Acumen Capable Could Needs

Clear and Benefit from Significant
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Strength Effective Development Improvement
 56. I know how to use financial information to make an impact on the
organization.

57. Understands business fundamentals and practices.

58. I am able to get department employees to accept new business

workflows.

59. You have a good understanding of liabilities and assets.

60. You anticipate marketplace opportunities and supports speed to

market.

What are your suggestions for how you can make improvements
in Business Acumen?

61. Strengths

62. Areas for Development

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

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