Please Print and Complete

 

To

 

Date

 

 

Directions: Write down the number that best describes your employer’s present behavior in relation to the following statements:

 

1. Your interaction with your boss or department.      2. The overall condition of the employer

 

(5) Always       (4) Usually      (3) Fairly often           (2) Occasionally          (1) Rarely       (0) Never

 

Please turn in to:

 

by

 

 

 

 

 

 

 

 

 

1) Boss or department

 

2) Employer

1.

My department/employer attacks the problem not the messenger.

 

 

 

 

 

 

 

2.

I feel free to resolve problems on the spot.

 

 

 

 

 

 

 

3.

I feel comfortable in speaking up when being asked a question.

 

 

 

 

 

 

 

4.

My department/employer has a real “open door policy”.

 

 

 

 

 

 

 

5.

During meetings, there is no fear of speaking up.

 

 

 

 

 

 

 

6.

Most of our communications are in written form.

 

 

 

 

 

 

 

7.

I helped write the procedures for my job.

 

 

 

 

 

 

 

8.

My job procedures are in written form.

 

 

 

 

 

 

 

9.

My jobs procedures are updated regularly.

 

 

 

 

 

 

 

10.

My department/employer has ongoing training programs.

 

 

 

 

 

 

 

11.

I have input on what training is needed.

 

 

 

 

 

 

 

12.

Our department/employer has a training budget and schedule.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

 

 

 

 

 

 

If your score falls between

48-60 Congratulations!!! Your employer has broken through The 4 Barriers To Quality©

24-47 You’re close: Pick up the training

0-23 Don’t worry. You can still formalize your training program.

 

Name

 

(optional)

 

 

Employer

 

 

Phone

 

Job Title

 

Not sure?

Fax

 

email

 

 

 

 

Are you management? (Please circle one)   1.Yes              2.No                3.Not Sure.

 

 

 

 

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