Personal Awareness Never Sometimes/
Occasionally

Fairly Often/
Pretty Well

Always/ Very
Well

Self-
Reflection

Do I regularly reflect on my
own cultural background
and how it influences my
perceptions and
interactions?

Awareness
of Biases

Am I aware of any personal
biases or stereotypes I may
hold about people from
different cultures?

Seeking
Knowledge

Do I actively seek to
understand the cultural
backgrounds of others?

Knowledge of Other Cultures Never Sometimes/
Occasionally

Fairly Often/
Pretty Well

Always/ Very
Well

Understanding
Diversity

Do I understand the key
components of different
cultures (such as beliefs,
values, customs, and
communication styles)?

Cultural
Sensitivity

Do I demonstrate
sensitivity and respect
towards cultural
differences?

Learning and
Education

Do I engage in learning
opportunities about
different cultures?

Interaction Skills Never Sometimes/
Occasionally

Fairly Often/
Pretty Well

Always/ Very
Well

Communication Do I effectively
communicate with
individuals from
different cultural
backgrounds?

Adaptability
Am I able to adapt my
behaviors and
attitudes when
interacting with
various cultures?

Conflict
Resolution

Can I manage
conflicts that may
arise due to cultural
misunderstandings
effectively?

Organizational Competence (if
applicable)

Never Sometimes/
Occasionally

Fairly Often/
Pretty Well

Always/ Very
Well

Policies and
Practices

Does my organization have
policies and practices that
promote cultural
competence?

Training and
Development

Does my organization
provide training on
cultural competence?

Inclusivity in
the
Workplace

Is the work environment
inclusive and respectful of
diverse cultures?

Commitment to Improvement Never Sometimes/
Occasionally

Fairly Often/
Pretty Well

Always/ Very
Well

Continuous
Learning

Do I seek feedback on my
intercultural interactions?

Feedback
Seeking

Am I aware of any personal
biases or stereotypes I may
hold about people from
different cultures?

Action Plan Do I have an action plan to
address areas where I need
to improve my cultural
competence?