Confidential Report Provided for:
Sample Employee

Communication
Question 1: Provides me with valuable information and feedback.
Question 2: Facilitates communication between departments and divisions.
Question 3: Informs employees on a regular basis about important information.

Customer Focus
Question 4: Goes above and beyond to service the needs of customers.

Innovation
Question 5: Creates new ideas and products that enhance our position in the marketplace.

Leadership
Question 6: Holds employees responsible for their actions and results.
Question 7: Provides valuable leadership and guidance.
Question 8: Helps align the work of others to support the goals of the organization.

Networking and Teamwork
Question 9: Supports activites and events that help integrate departments.
Question 10:Works with others to achieve goals and objectives.

How Are We Communicating?
Question 11: The HR Department provides me with excellent information.
Question 12: The Senior Leadership Team keeps us up-to-date about company issues.
Question 13: My Supervisor provides me with good information.

About [Company]
Question 14: I think that [Company] is an excellent place to work.


  1. Has clarified her/her expectations of my job duties.
  1. Facilitates communication between departments and divisions.
  1. Informs employees on a regular basis about important information.
  1. Goes above and beyond to service the needs of customers.
  1. Creates new ideas and products that enhance our position in the marketplace.
  1. Holds employees responsible for their actions and results.
  1. Provides valuable leadership and guidance.
  1. Helps align the work of others to support the goals of the organization.
  1. Supports activites and events that help integrate departments.
  1. Works with others to achieve goals and objectives.

  1. The HR Department provides me with excellent information.
  1. The Senior Leadership Team keeps us up-to-date about company issues.
  1. My Supervisor provides me with good information.
  1. I think that [Company] is an excellent place to work.

Comment Report

Comments from employees would be listed here.

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