Company Name

Information About You

Department:
Accounting

Legal and Copyright

Customer Service

Payroll

Finance

Physical Plant

Human Resources

Research and Development

Job Classification:
Supervisor/manager
Non-supervisory/eligible for overtime (non-exempt)
Non-supervisory/not eligible for overtime (exempt)
Director and above
Temporary Clerical Staf

Length of Service:
Less than one year

Five to nine years

One to two years

Ten to nineteen years

Three to four years

Twenty years or more

FEEDBACK ABOUT YOUR SUPERVISOR

Neither
Disagree Agree Nor Agree
Disagree

My Supervisor:
1. Treats me fairly
2. Brings out the best in employees
3. Treats me with respect
4. Takes initiative when solving problems
5. Develops new strategies
6. Applies policies and regulations fairly
7. Is skilled in conflict resolution
8. Handles my work-related issues satisfactorily

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Neither
Disagree Agree Nor Agree
Disagree

My Supervisor:
9. Builds loyalty in others
10. Tells me when my work needs improvement
11. Expects and demands superior job performance
12. Explores new and exciting opportunities
13. Challenges the abilities of other employees
14. Tells me when I do my work well
15. Asks me for my input to help make decisions
16. Gives good, practical advice
17. Communicates decisions with confidence
18. Is open-minded
19. Handles disruptive employees efectively
20. Is well informed
21. Efectively settles disciplinary problems
22. Usually rewards hard work
23. Recognizes when I do a good job
24. Encourages me to create innovative solutions
25. Allows me to develop professionally
26. Allows me to obtain necessary training
27. Helps me to feel secure in my job
28. Sets high standards for themselves
29. Provides the necessary resources to perform my job
30. Makes good use of my skills and abilities
31. Thinks through alternatives
32. Enables me to be more efective in my job
33. Supports the use of technology to do my job
34. Establishes clear expectations
35. Provides the equipment I need to do my job well

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Neither
Disagree Agree Nor Agree
Disagree

My Supervisor:
36. Has a clear idea of my job responsibilities
37. Accepts constructive criticism
38. Leads by example
39. Ofers me the flexibility I want
40. Provides me with adequate feedback
41. Holds me accountable for the work that I do
42. Rewards people according to their accomplishments
43. Sets challenging performance goals for my job
44. Evaluates all options before acting
45. Efectively resolves department conflicts
46. Is committed to organizational goals
47. Is an efective leader
48. Understands our needs
49. Communicates efectively
50. Develops innovative solutions
51. Is someone I trust
52. Sets a good example
53. Shows an eagerness to improve
54. Encourages my development
55. Inspires future success
56. Thinks before taking action

FEEDBACK ABOUT MANAGEMENT

Neither
Disagree Agree Nor Agree
Disagree

Management:
1. Brings out the best in employees
2. Treats employees with fairness and respect

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Neither
Disagree Agree Nor Agree
Disagree

Management:
3. Develops appropriate solutions
4. Identifies root causes of problems
5. Treats employees with respect
6. Demonstrates that employees are important to the
success of the organization
7. Provides a clear picture of where the organization is
headed
8. Can be trusted to make sensible decisions for the
organization
9. Practices what they preach
10. Inspires future success
11. Encourages my development
12. Shows an eagerness to improve
13. Sets a good example
14. Develops innovative solutions
15. Communicates efectively
16. Understands our needs
17. Is committed to organizational goals
18. Efectively resolves department conflicts
19. Evaluates all options before acting
20. Sets challenging performance goals
21. Rewards people according to their accomplishments
22. Holds employees accountable for the work that they
do
23. Provides me with adequate feedback
24. Ofers me the flexibility I want
25. Leads by example
26. Accepts constructive criticism
27. Has a clear idea of my job responsibilities

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Neither
Disagree Agree Nor Agree
Disagree

Management:
28. Provides the equipment I need to do my job well
29. Establishes clear expectations
30. Supports the use of technology in the workplace
31. Enables me to be more efective in my job
32. Thinks through alternatives
33. Makes good use of my skills and abilities
34. Provides the necessary resources to perform my job
35. Sets high standards for others
36. Sets high standards for themselves
37. Allows me to obtain necessary training
38. Supports my professional development
39. Encourages creative and innovative solutions
40. Recognizes when I do a good job
41. Efectively settles disciplinary problems
42. Is well informed
43. Handles disruptive employees efectively
44. Is open-minded
45. Communicates decisions with confidence
46. Gives good, practical advice
47. Asks for my input to help make decisions
48. Recognizes employees for good work
49. Challenges the abilities of employees
50. Explores new and exciting opportunities
51. Expects and demands superior job performance
52. Evaluates performance of administrative functions
53. Fosters loyalty in employees
54. Applies policies and regulations fairly

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Neither
Disagree Agree Nor Agree
Disagree

Management:
55. Develops new strategies
56. Considers innovative solutions to problems

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Your Comments
What is lacking in your work environment that might help you perform
better?

What would make our organization more efective?

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