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0%
 
 
Senior Management gives team members a clear picture of the direction the [Company] is headed.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
I am satisfied with the strategic direction of the company.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
Upper management seems willing to invest in the development of new team members.

 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
Upper management seems willing to accept mistakes made in the process of trying new things.

 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
Upper management understands the problems we face on our jobs.


 
Strongly Disagree
 
Somewhat Disagree
 
Undecided
 
Somewhat Agree
 
Strongly Agree
 
 
 
Upper management treats me with respect.

 
Strongly Disagree
 
Somewhat Disagree
 
Undecided
 
Somewhat Agree
 
Strongly Agree
 
 
 
Overall, how satisfied are you with the job being done by your immediate supervisor?
 
Very Dissatisfied
 
Somewhat Dissatisfied
 
Undecided
 
Somewhat Satisfied
 
Very Satisfied
 
 
Training Services Evaluation

How satisfied are you:
Very    
Satisfied    
Satisfied     Neutral     Dissatisfied     Very    
Dissatisfied    
Not applicable/
Not sure
Relevance of courses with respect to your needs?
s training personnelÂ’s knowledge and professionalism? COMPANY
The location and quality of training facilities?
s communication of the training packages available to you or your department? COMPANY
Overall with the s training program? COMPANY
 
 
 
What should [COMPANY] do to improve the quality of its training services?
   
 
 
 
[COMPANY] understands the training needs of my department
 
Strongly agree
 
Agree
 
Neutral
 
Disagree
 
Strongly disagree
 
Not sure
 
 
 
Overall, the value of training compared with the price paid is:
 
Excellent
 
Very good
 
Good
 
Fair
 
Poor
 
Not sure
 
 
How satisfied are you:
Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied
with the quality of the overall event?
with the scope of information presented?
with the usefulness of the information?
with the quality of the presentations in the general sessions?
with the overall meeting format's emphasis on training?
that you had sufficient time to network and share ideas with your peers?
with the amount of time dedicated to training?
with the meetings' overall value in helping you improve your professional effectiveness?
that the meeting was a motivational experience for you?
that you and your peers received appropriate recognition and appreciation at the meeting for your contributions last year?
 
 
 
Do you presently have a dentist that you visit on a regular basis?
 
Yes
 
No
 
 
 
How did you find your dentist?
 
Referral by friend/neighbor
 
Referral by acquaintance
 
Referral by another dentist
 
Referral by doctor
 
Advertisement
 
Phone book
 
Saw office/sign
 
Other
 
 
 
 
Do members of your household go to (check all that apply):
 
One dentist
 
More than one dentist
 
An orthodontist
 
An oral surgeon
 
Other dental specialist
 
Other
 
 
 
 
The most common reason for not going to the dentist is:
 
I do go for regular check-ups
 
Transportation
 
The cost of care
 
I don't need to go very often
 
I forget to go
 
I don't like dentists
 
There is nothing wrong with my teeth
 
Other
 
 
 
Since when have you made regular visits to the current dentist?
 
< 6 months
 
6 months - 1 year
 
1-2 years
 
2-3 years
 
3-4 years
 
4+ years
 
 
 
How often do you go to the dentist for checkups?
 
Every 6 months
 
At least once a year
 
At least every 2 years
 
At least once every 3-4 years
 
It depends, I go when I have trouble with my teeth
 
 
 
Would you like your dentist to notify you when it is time for a 6-month check-up?
 
Yes
 
No
 
Not sure
 
 
 
If you would like your dentist to notify you when it is time for a check-up, how would you prefer to receive this notice?
 
Phone call
 
Mail
 
E-mail
 
Other
 
 
 
 
If two weeks go by and you had not yet made an appointment, would you like them to call back again?
 
Yes
 
No
 
Not sure
 
 
 
I would prefer the following payment plan for my dental care:
 
Payment required at the time of care (cash/check)
 
Payment by charge cards at the time of care (VISA, Mastercard, etc.)
 
Monthly payment plan at 1.5% interest per month
 
Payment due within 30 days
 
Other
 
 
 
 
Dental charges may vary subject to the amount of time that the dentist takes to complete a procedure, as well as the kind of work performed. If the cost were the same, what kind of dentist would you prefer?
 
Takes a little longer to get the job done, but talks to you during the procedure (cost $45, 45 minutes time)
 
Completes the work more rapidly and talks less (cost $45, 30 minutes time)
 
Completes the work very rapidly (cost $45, 20 minutes time)
 
 
 
Would you expect the dentist who takes longer to do a better job?
 
Yes
 
No
 
Not sure
 
 
 
What do you like best about your personal dentist?
   
 
 
 
What would you suggest that might make a visit to your dentist more pleasurable?
   
 
 
 
In your opinion, how have patient satisfaction ratings changed at your organization in the past year?
 
Improved considerably
 
Improved somewhat
 
Has remained about the same
 
Has declined somewhat
 
Has declined considerably
 
Don't know
 
 
 
In your opinion, how important is patient satisfaction at your organization?
 
It's a high priority
 
It's a mid-level priority
 
It's a low priority
 
Don't know
 
 
 
Does your organization have managers/staff dedicated to patient-satisfaction matters?
 
Yes
 
No
 
Don't know
 
 
 
How often does your organization track patient satisfaction?
 
Daily basis for each patient
 
Monthly or more often
 
Quarterly
 
Semiannually
 
Yearly or less often
 
We don't
 
 
 
How is patient satisfaction primarily tracked?
 
Questionnaires sent through the mail (in-house efforts)
 
Follow-up telephone calls (in-house efforts)
 
An outside firm has been hired to track patient satisfaction
 
Suggestion boxes placed in facilities
 
Other
 
 
 
 
Has your organization initiated programs to improve patient satisfaction within the past year?
 
Yes
 
No
 
Don't know
 
 
 
In your opinion, has patient satisfaction been shown to have a direct effect on your organization's bottom line?
 
Yes
 
No
 
Don't know
 
 
The Job Itself



1
Strongly Disagree
2
Disagree
3
Neutral
4
Agree
5
Strongly Agree
Job was challenging
Skills were effectively used
Job orientation was effective
Work load was reasonable
Sufficient resources were available
Work environment was safe, comfortable and appropriately equipped
 
 
My Supervisor



1
Strongly Disagree
2
Disagree
3
Neutral
4
Agree
5
Strongly Agree
Had knowledge of the job
Had knowledge of supervision
Was open to suggestions
Recognized employees contribution
 
 
The Management



1
Strongly Disagree
2
Disagree
3
Neutral
4
Agree
5
Strongly Agree
Gave fair and equal treatment
Was available to discuss job related issues
Welcomed suggestions and encouraged feedback
Maintained consistent policies and practices
Provided recognition for achievements
Encouraged cooperation/collegiality
Provided development opportunities
 
 
Tell us how well the following statements apply to your immediate boss/superior.
Strongly Disagree Disagree Neither Agree or Disagree Agree Strongly Agree
My supervisor is knowledgeable about my work
My supervisor takes time to listen to me
My supervisor gives me fair reviews
My supervisor has reasonable expectations of my work
My supervisor is willing to promote me
My supervisor trains me in whenever necessary
My supervisor makes sure I have sufficient training
 
 
 
Overall, how satisfied are you with the company you work for?
 
Extremely Dissatisfied
 
Very Dissatisfied
 
Neither Satisfied nor Dissatisfied
 
Very Satisfied
 
Extremely Satisfied
 
 
Please rate your satisfaction with employee benefits and policies of your organization.
Not At All Satisfied Somewhat Dissatisfied Neither Satisfied nor Dissatisfied Somewhat Satisfied Very Satisfied
Accuracy of job description
Salary reviews
Adequate information on promotion is provided
Leaves of absence
Health care benefits
Retirement benefits
Listening to the employee in employer/employee disputes
 
 
 
How well do you believe your manager lives by your company's ethic?
 
Extremely well
 
Very well
 
Sometimes does, sometimes doesn't
 
Not very well
 
Doesn't abide by own philosophy at all
 
 
 
If you have ever offered suggestions to management, how satisfied were you with the response?
 
Never offered a suggestion
 
Not at all satisfied
 
Not very satisfied
 
Somewhat satisfied
 
Very satisfied
 
 
 
How long have you been working for the company?
 
Less than a year
 
1-2 years
 
3-5 years
 
6-10 years
 
More than 10 years
 
 
 
This meeting is scheduled for [ ] minutes, what is the maximum amount of time you can spend at this meeting.
 
15 minutes
 
30 minutes
 
1 hour
 
2 hours
 
Other
 
 
 
 
Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree
I feel encouraged to come up with new and better ways of doing things.
My work gives me a feeling of personal accomplishment.
I have the tools and resources to do my job well.
On my job, I have clearly defined quality goals.
The Company does an excellent job of keeping employees informed about matters affecting us.
When a customer is dissatisfied, I can usually correct the problem to their satisfaction.
I understand why it is so important for (Company name) to value diversity (to recognize and respect the value of differences in race, gender, age, etc.)
My job makes good use of my skills and abilities.
My supervisor's manager visibly demonstrates a commitment to quality.
Senior managers visibly demonstrate a commitment to quality.
How satisfied are you with the information you receive from management on what is going on in your division?
How satisfied are you with your involvement in decisions that affect your work?
Considering everything, how satisfied are you with your job?
How satisfied are you with the information you receive from management on what's going on in the company?
How satisfied are you with your opportunity to get a better job in this company?
 
 
 
Overall, how satisfied are you with communications in your company?
 
Very satisfied
 
Satisfied
 
Neutral
 
Dissatisfied
 
Very dissatisfied
 
 
 
Which best describes your impression of communications within your company?
 
Keeps us fully informed
 
Keeps us fairly well informed
 
Keeps us adequately informed
 
Gives us only a limited amount of information
 
Doesn't tell us much at all about what's going on
 
 
 
How do you feel about the information you receive?
 
I can almost always believe it.
 
I can usually believe it.
 
I can believe it about half the time.
 
I usually can't believe it.
 
I can almost never believe it.
 
 

How would you rate your manager's communication skills?
 
Excellent
 
Very good
 
Good
 
Fair
 
Poor
 
 
 
Do you feel that employees are recognized as individuals?
 
Always
 
Usually
 
Sometimes
 
Rarely
 
Never
 
Not sure
 
 
 
How motivated areyou to see the company succeed?
 
Very motivated
 
Somewhat motivated
 
Not very motivated
 
Not at all motivated
 
Not sure
 
 
 
The company clearly communicates its goals and strategies to me?
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
How flexible is the company with respect to your family responsibilities?
 
Very inflexible
 
Somewhat inflexible
 
Neutral
 
Somewhat flexible
 
Very flexible
 
 
 
Would you refer a friend to apply for a job at this company?
 
Definitely
 
Probably
 
Not sure
 
Probably not
 
Definitely not
 
 
 
The company clearly communicates its goals and strategies to me?
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
My job requirements are clear.



 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
The amount of work I am expected to do on my job is reasonable.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
I am satisfied with the productivity and efficiency of my department
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
I have enough information to do my job well.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
My department operates in a cost-efficient manner.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
Considering everything, how satisfied are you with your job?
 
Very Dissatisfied
 
Somewhat Dissatisfied
 
Undecided
 
Somewhat Satisfied
 
Very Satisfied
 
 
 
I believe I will be working for [Company]in five years.


 
Strongly Disagree
 
Somewhat Disagree
 
Undecided
 
Somewhat Agree
 
Strongly Agree
 
 
 
I would choose [Company] again if I had a job choice to make.



 
Strongly Disagree
 
Somewhat Disagree
 
Undecided
 
Somewhat Agree
 
Strongly Agree
 
 
 
I would recommend [Company] as a career to my friends.




 
Strongly Disagree
 
Somewhat Disagree
 
Undecided
 
Somewhat Agree
 
Strongly Agree
 
 
 
Team members are held accountable for the decisions they make.
 
Strongly Disagree
 
Somewhat Disagree
 
Undecided
 
Somewhat Agree
 
Strongly Agree
 
 
 
Work assignments are distributed fairly.
 
Strongly Disagree
 
Somewhat Disagree
 
Undecided
 
Somewhat Agree
 
Strongly Agree
 
 
 
Sufficient effort is made to get the opinions and ideas of the employees.

 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
Overall, how satisfied are you with the spirit of teamwork within [Company].



 
Dissatisfied
 
Somewhat dissatisfied
 
Neutral
 
Satisfied
 
Very Satisfied
 
N/A
 
 
 
There are more positive than negative aspects to my job.
 
Strongly Disagree
 
Disagree
 
Neutral
 
Agree
 
Strongly Agree
 
 
 
My immediate supervisor is impartial.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
My immediate supervisor gives me feedback that helps me improve my performance.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
My immediate supervisor follows through on commitments.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
I receive coaching and training from my immediate supervisor.
 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
My immediate supervisor is usually available.

 
Strongly Disagree
 
Somewhat Disagree
 
Neutral
 
Somewhat Agree
 
Strongly Agree
 
N/A
 
 
 
I recieve credit from my immediate supervisor for a job well done.


 
Strongly Disagree
 
Somewhat Disagree
 
Undecided
 
Somewhat Agree
 
Strongly Agree
 
 
 
I feel my job perfomance is fairly evaluated.



 
Strongly Disagree
 
Somewhat Disagree
 
Undecided
 
Somewhat Agree
 
Strongly Agree
 
 
 
My immediate supervisor tries to understand my point of view when he or she discusses problems or projects with me.
 
Strongly Disagree
 
Somewhat Disagree
 
Undecided
 
Somewhat Agree
 
Strongly Agree
 
 
 
My immediate supervisor creates a vision and strategy for my area.
 
Strongly Disagree
 
Somewhat Disagree
 
Undecided
 
Somewhat Agree
 
Strongly Agree
 
 
 
Overall, how satisfied are you with the job being done by your immediate supervisor.
 
Very Dissatisfied
 
Soemwhat Dissatisfied
 
Undecided
 
Somewhat Satisfied
 
Very Satisfied
 
 
 
Overall, how satisfied are you with your job?

 
Dissatisfied
 
Somewhat dissatisfied
 
Neutral
 
Satisfied
 
Very Satisfied
 
 
 
Compared to a year ago how would you describe your current job satisfaction level?
 
Much less satisfied
 
Somewhat less satisfied
 
Same
 
Somewhat more satisfied
 
Much more satisfied
 
 
How satisfied are you...
Very dissatisfied     Somewhat dissatisfied     Neutral     Somewhat satisfied     Very satisfied     N/A
With the leaders in your company as positive role models?
Your direct supervisor as a positive role model?
That your supervisor cares about and is responding to the issues that are important to you?
With your own morale?
With the morale of your co-workers?
With the team spirit in your work environment.
With the professionalism of your co-workers?
That your work gives you a feeling of personal accomplishment?
That you receive appropriate recognition for your contributions?
With the empowerment you have to influence the quality of your work?
With your ability to maintain a reasonable balance between your family life and your work life.
That your compensation matches your responsibilities?
With your overall job security?
With the amount and frequency of informal praise and appreciation you receive from your supervisor?
With the company as a place to work?
 
 
 
How long have you worked at (company)?
 
Less than 6 months
 
6 months - 1 year
 
1-2 YEARS
 
1-2 years
 
3-5 years
 
More than 5 years
 
 
 
Overall how satisfied are you with your position at this company?
 
Very dissatisfied
 
Somewhat dissatisfied
 
Not satisfied or dissatisfied
 
Somewhat Satisfied
 
Very satisfied
 
 
 
Do you feel that employees are recognized as individuals?
 
Always
 
Usually
 
Sometimes
 
Rarely
 
Never
 
Not sure
 
 
 
How motivated are you to see the company succeed?
 
Very motivated
 
Somewhat motivated
 
Not very motivated
 
Not at all motivated
 
Not sure
 
 
 
The company clearly communicates its goals and strategies to me?
 
Strongly disagree
 
Somewhat disagree
 
Don't agree or disagree
 
Somewhat agree
 
Strongly agree
 
 
 
How flexible is the company with respect to your family responsibilities?
 
Very inflexible
 
Somewhat inflexible
 
Neither
 
Somewhat flexible
 
Very flexible
 
 
 
Would you refer a friend to apply for a job at this company?
 
Definitely
 
Probably
 
Not sure
 
Probably not
 
Definitely not
 
 
 
Which of the following describes the variety of tasks required by your position?
 
Too many
 
Enough
 
Not enough
 
 
 
My job requirements are clear




 
Strongly disagree
 
Somewhat disagree
 
Neither agree nor disagree
 
Somewhat agree
 
Strongly agree
 
 
How would you rate your manager in each of the following areas? Please assign a rating on a scale from 1 to 5, where 1 represents "Poor" and 5 represents "Excellent".
Poor    Average    Good    Very Good    Excellent   
Communication
Planning and organizing
Directing and coordinating
Job/Technical knowledge
Interpersonal relationship
 
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