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 Staff

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
My Supervisor: Disagree Agree Nor Agree
Disagree

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
My Supervisor: Disagree Agree Nor Agree
Disagree

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 effectively

20. Is well informed

21. Effectively 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 effective 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
My Supervisor: Disagree Agree Nor Agree
Disagree

36. Has a clear idea of my job responsibilities

37. Accepts constructive criticism

38. Leads by example

39. Offers 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. Effectively resolves department conflicts

46. Is committed to organizational goals

47. Is an effective leader

48. Understands our needs

49. Communicates effectively

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
Management: Disagree Agree Nor Agree
Disagree

1. Brings out the best in employees

2. Treats employees with fairness and respect

3. Develops appropriate solutions

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 Neither
Management: Disagree Agree Nor Agree
Disagree

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 effectively

16. Understands our needs

17. Is committed to organizational goals

18. Effectively 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. Offers me the flexibility I want

25. Leads by example

26. Accepts constructive criticism

27. Has a clear idea of my job responsibilities

28. Provides the equipment I need to do my job well

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 Neither
Management: Disagree Agree Nor Agree
Disagree

29. Establishes clear expectations

30. Supports the use of technology in the workplace

31. Enables me to be more effective 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. Effectively settles disciplinary problems

42. Is well informed

43. Handles disruptive employees effectively

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

55. Develops new strategies

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 Neither
Management: Disagree Agree Nor Agree
Disagree

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 effective?

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