|  
| Please indicate the team you are on (You may choose more than one if applicable) |  
  |   |  
 |  
  |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| I see evidence of effective leadership from the Impact Leadership Team (ILT). |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| The ILT provides clear direction for the future. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| The ILT is clear, open, honest and communicates regularly. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| My leader encourages imagination and creativity. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| My leader leads by example. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| My leader makes sure I clearly understand what tasks have to be done. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| My leader is accessible when needed. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| My leader personally recognizes my accomplishments when I do a good job. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| My leader provides constructive performance feedback. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| There are sufficient opportunities for me to improve my skills in my current role. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| I have the authority to make the decisions necessary to do my job well. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| I feel encouraged to come up with new and better ways of doing things. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| I have the information, tools and resources I need to do my job well. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| My job makes good use of my skills and abilities. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| Impact supports the growth and development of its team members. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| Impact respects team members of different ages, race, gender, sexual orientation, religions, ethnic origin, language, marital status, family status, and disability. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| I believe Impact is positioned well for future success. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
 |  
| I am proud to be part of the Impact team. |  
  |   |  
 |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 | 
            
        
        
    
        
            
                
                
                       
|   |  
 |  Please free to add any additional comments and suggestions that you have.  |   |   |  
  |   
                 
                
             | 
        
        
        
        
        
        
            
                | 
                       
                 |