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Questions marked with an * are required Exit Survey
 
 
* Please Select Location Identifier.
 
L1
 
L2
 
 
 
* Please Select Day.
 
1
 
2
 
3
 
4
 
5
 
 
 
* Select Role Type.
 
(1) Interpersonal
 
(2) Information
 
(3) Decisional
 
 
 
* Select Role.
 
(1) Figurehead
 
(2) Leader
 
(3) Liaison
 
(4) Monitor
 
(5) Disseminator
 
(6) Spokesperson
 
(7) Entrepreneur
 
(8) Distrubance Handler
 
(9) Resource Allocator
 
(10) Negotiator
 
 
 
* Select Activity Type.
 
(1a) Signs/Authorizes Business Docs
 
(1b) Signs/Authorizes Contracts or Agreements
 
(1c) Signs/Authorizes Ceremonial Docs
 
(1d) Receives Visitors
 
(1e) Conducts Tour
 
(2a) Motivates Employee
 
(2b) Hires Faculty or Staff
 
(2c) Trains Employee
 
(2d) Disciplines Faculty or Staff
 
(2e) Attends Campus Program or Building Development
 
(3a) Joins or Participates in Networking
 
(3b) Makes or Meets a Political Relationship
 
(4a) Incoming Telephone Calls
 
(4b) Attend Scheduled Meeting
 
(4c) Attend Un-Scheduled Meeting
 
(4d) Scan / Read Publications
 
(4e) Scan / Read Reports
 
(4f) Read Email
 
(4g) Scan Email
 
(4h) Receives and Reads Email
 
(4i) Attends Meeting Where He/She Receives Information
 
(5a) Communication Decision Process
 
(5b) Mail (Writes or dictate letter/memo)
 
(5c) Email (Writes or dictate letter/memo)
 
(5d) Phone Call
 
(6a) Communication Decision Process
 
(6b) Mail (Writes or dictate letter/memo)
 
(6c) Email (Writes or dictate letter/memo)
 
(6d) Phone Call
 
(6e) Setup Future Meeting
 
(6f) Attend New Conference
 
(7a) Solutions and Improvements to Problems, Challenges, or Situations
 
(8a) Corrective Action: Student
 
(8b) Corrective Action: Staff
 
(8c) Corrective Action: Outsider
 
(8d) Corrective Action: Other
 
(8e) On Campus Problem (Security / Other)
 
(9a) Resource Decision: Money
 
(9b) Resource Decision: Time
 
(9c) Resource Decision: Materials
 
(9d) Resource Decision: Equipment
 
(9e) Resource Decision: Other
 
(9f) Budgeting
 
(10a) Union / Bargaining
 
(10c) Vendors and Bid Activities
 
Other
 
 
 
 
Optional Activity Data Elements
 
 
Group / Person Name:
   
 
 
Title:
   
 
 
Location:
   
 
 
People Present:
   
 
 
Comments/Suggestions:
   
 
 
Activity Duration in Minutes: