The Company
 
Sample Company Practices Survey

Courtesy of eXpert Survey Systems, Inc.
General Instructions for Completing the Questionnaire
 
This questionnaire is designed to assess where we have sound practices and where we may need improvement in our The Company work. Please note that there are three sections to this survey. The first part asks you to assess your own actions or behaviors. The second part asks you to assess the actions or behaviors of those in your business unit. And the third part asks you to assess the actions or behaviors of the senior management team. You will also have the opportunity to write in comments at the end.

For the results to be useful, it is important that you provide an accurate picture of how you see things. Your individual responses, which will be anonymous and combined with those of other respondents, will be tabulated by eXpert Survey Systems, Inc.
 
If you have any questions about the content of this survey, please contact Dr. Joe on 123-456-7890. However, if you have difficulty operating the survey, please contact the Help Desk at 123-456-7890.

To respond to an item, please click in the circle that best corresponds to your opinion. When you have completed the survey, please click on the submit button. It should only take you approximately 20 minutes to complete this survey.
PART 1 - SELF-ASSESSMENT

In this section, please indicate the extent to which you engage in the following behaviors.
I. HONESTY, RESPECT AND CIVILITY
 
Q1 Please rate the extent to which you...
... are fair from person to person and situation to situation.
Not At All
 
To A Little Extent
 
To Some Extent
 
To a Great Extent
 
To A Very Great Extent
  ...act respectful in demeanor-tone, language and nonverbal communication.        
  ...treat all people with dignity.        
  ...genuinely listen to the views expressed by others.        
II. STRIVE FOR EXCELLENCE
 
Q2 Please rate the extent to which you...
...expose your thinking to critical review.
Not At All
 
To A Little Extent
 
To Some Extent
 
To A Great Extent
 
To a Very Great Extent
  ...have high standards for the quality of your work.        
  ...seek opportunities for improvement.        
  ...maintain ethical standards under pressure to perform.        
III. CONTRIBUTE YOUR INDIVIDUAL EXCELLENCE TO TEAM EFFORT
 
Q3 Please rate the extent to which you...
...contribute skills, knowledge and leadership to team effort.
Not At All
 
To A Little Extent
 
To Some Extent
 
To A Great Extent
 
To A Very Great Extent
  ...respect contributions of others.        
  ...come to meetings prepared and ready to make a contribution.        
IV. EMBRACE DIVERSITY
 
Q4 Please rate the extent to which you...
...speak out against intolerant or discriminatory behavior.
Not At All
 
To A Little Extent
 
To Some Extent
 
To A Great Extent
 
To A Very Great Extent
  ...test preconceived notions before acting on those notions.        
  ...solicit and listen to a variety of viewpoints.        
  ...act responsibly on the needs of the different communities that we serve.        
  ...treat people fairly without regard to their race, ethnicity, age, gender, religious beliefs, sexual orientation or disability.        
V. TAKE RISKS AND INNOVATE
 
Q5 Please rate the extent to which you...
...contribute ideas characterized by innovation, creativity and experimentation.
Not At All
 
To A Little Extent
 
To Some Extent
 
To A Great Extent
 
To A Very Great Extent
  ...work to turn ideas into action.        
  ...act decisively in the face of ambiguity.        
  ...support good ideas even though success may be uncertain.        
  ...abandon ineffective strategies or actions when necessary.        

VI. INFORMATION IS POWER; SHARE IT
 
Q6 Please rate the extent to which you...
...share more rather than less information.
Not At All
 
To A Little Extent
 
To Some Extent
 
To A Great Extent
 
To A Very Great Extent
  ...test assumptions about what information is needed.        
  ...make time to share information with others.        
VII. GIVE AND ACCEPT CONSTRUCTIVE FEEDBACK
 
Q7 Please rate the extent to which you...
...give fair, balanced and candid feedback.
Not At All
 
To A Little Extent
 
To Some Extent
 
To A Great Extent
 
To A Very Great Extent
  ...recognize when and where it is appropriate to give feedback.        
  ...seek out the facts to make feedback useful and correct.        
  ...ensure that messages are clear.        
  ...praise others for a job well done.        
VIII. ACCEPT RESPONSIBILITY; DELEGATE AUTHORITY
 
Q8 Please rate the extent to which you...
...encourage others to participate in leadership, management and decision making.
Not At All
 
To A Little Extent
 
To Some Extent
 
To A Great Extent
 
To A Very Great Extent
  ...invest the time to prepare others to accept responsibility.        
  ...look for opportunities to highlight the contribution of others.        
  ...step forward when things go wrong; hold yourself accountable.        
  ...take ownership of problems; find solutions.        
IX. MAINTAIN PERSPECTIVE AND A SENSE OF HUMOR
 
Q9 Please rate the extent to which you...
...keep an even keel under pressure.
Not At All
 
To A Little Extent
 
To Some Extent
 
To A Great Extent
 
To A Very Great Extent
  ...balance the attention given to success and failures.        
  ...have a sense of proportion; don't sweat the small stuff.        
  ...seek help and support when needed.        
  ...take bad news gracefully.        
PART 2-BUSINESS UNIT
 
Q10 In this section, please indicate the extent to which you believe people in your business unit...
...treat each other with honesty, respect and civility.
Not At All
 
To A Little Extent
 
To Some Extent
 
To A Great Extent
 
To A Very Great Extent
 
Don't Know
  ...embrace diversity.          
  ...give and accept constructive feedback.          
  ...accept responsibility; delegate authority.          
  ...maintain perspective and a sense of humor.          
PART 3-THE SENIOR MANAGEMENT TEAM
 
Q11 In this section, please indicate the extent to which you believe the Senior Management Team...
...treats each other with honesty, respect and civility.
Not At All
 
To A Little Extent
 
To Some Extent
 
To A Great Extent
 
To A Very Great Extent
 
Don't Know
  ...embraces diversity.          
  ...gives and accepts constructive feedback.          
  ...accepts responsibility; delegates authority.          
  ...maintains perspective and a sense of humor.          
Q12 If you have any other comments, please write them below.
 
Q13 Please indicate your region:
 
Northeast
Southeast
Central
Midwest
West Coast
Corporate
Please click on SUBMIT button below to submit your survey.

Thank you for your participation.