CONFIDENTIAL


ABC Organization

LEADERSHIP & MANAGEMENT
COMPETENCY PROFILE

 for

Janet

Introduction

Sample Survey
          
    Janet is participating in a professional development process which requires feedback from several people with whom she works. The information gathered will help Janet target her most important professional development opportunities. 

    Please complete this survey by indicating the extent to which Janet typically engages in each of the behaviors listed. Please answer in terms of how she typically behaves - on most days, on most projects, with most people. 

    You will also be asked to answer in your own words a couple of open-ended questions about Janet's strengths and opportunities for improvement. Since this feedback will be of great value to her, we strongly urge you to provide comments in the text areas. 

    Your individual responses will remain anonymous. Numeric responses will be aggregated and combined with the responses given by other respondents. Written responses will be presented verbatim and merged with the written comments of others.  


    EXCEPTION:  Please note that if you are Janet's supervisor, your data will be reported separately and Janet will be able to identify your feedback.
    ATTENTION!  Please answer all questions.  The survey program will automatically prevent the submission of partially completed surveys by pointing you toward the question(s) left unanswered.  
    If you feel that you cannot complete the survey to your satisfaction at this time, close your browser and begin anew at your convenience.

    Deadline:  The survey must be completed and submitted no later than the end of work May 20.   Thank you.

 
Your Relationship to this Person:

I am a member of this person's staff
I am a co-worker with this person
Self
I supervise this person
To what extent does this person typically engage in the following behaviors?   Check the number that best applies to each statement.  If you cannot respond to the statement, check Don't Know.
Adaptability
1=Strongly Disagree  2=Disagree  3=Neither Agree nor Disagree   4=Agree  5=Strongly Agree
DK/NA = Don't Know or Not Applicable
Q1Willing and able to handle new requirement, assignments, and/or challenges.
1 2 3 4 5 DK/NA
Q2Flexible; good at varying her approach with the situation.
1 2 3 4 5 DK/NA
Q3Willing to adjust her point of view when new data becomes available.
1 2 3 4 5 DK/NA
Communication
1=Strongly Disagree  2=Disagree  3=Neither Agree nor Disagree   4=Agree  5=Strongly Agree
DK/NA = Don't Know or Not Applicable
Q4Is professional and effective in interpreting and conveying (written and verbal) internal and external information.
1 2 3 4 5 DK/NA
Q5Promotes a free flow of information and communication throughout the organization.
1 2 3 4 5 DK/NA
Q6Projects credibility and poise, even in highly visible, adversarial situations.
1 2 3 4 5 DK/NA
Q7Resolves conflict effectively.
1 2 3 4 5 DK/NA
Decision Making/Judgment
1=Strongly Disagree  2=Disagree  3=Neither Agree nor Disagree   4=Agree  5=Strongly Agree
DK/NA = Don't Know or Not Applicable
Q8Reasons through information and comes to logical conclusions in a timely and effective manner.
1 2 3 4 5 DK/NA
Q9Is consistent in the proper identification, analysis, and resolution of problems.
1 2 3 4 5 DK/NA
Q10Makes appropriate decisions after considering all relevant factors and evaluating the probable outcome of alternatives.
1 2 3 4 5 DK/NA
Initiative/Resourcefulness
1=Strongly Disagree  2=Disagree  3=Neither Agree nor Disagree   4=Agree  5=Strongly Agree
DK/NA = Don't Know or Not Applicable
Q11Originates and contributes new ideas/methods.
1 2 3 4 5 DK/NA
Q12Exercises and encourages self-reliance, planning and ingenuity.
1 2 3 4 5 DK/NA
Q13Seeks out and takes advantage of opportunities for self-development beyond current job responsibilities.
1 2 3 4 5 DK/NA
Job Skills/Functional Knowledge
1=Strongly Disagree  2=Disagree  3=Neither Agree nor Disagree   4=Agree  5=Strongly Agree
DK/NA = Don't Know or Not Applicable
Q14Demonstrates knowledge and skills necessary to do the job.
1 2 3 4 5 DK/NA
Q15Demonstrates knowledge and understanding of Organization policies and practices in carrying out job responsibilities.
1 2 3 4 5 DK/NA
Q16Stays current on job-related information.
1 2 3 4 5 DK/NA
Organization/Planning
1=Strongly Disagree  2=Disagree  3=Neither Agree nor Disagree   4=Agree  5=Strongly Agree
DK/NA = Don't Know or Not Applicable
Q17Uses resources (funding, people, time) effectively and efficiently to get things done.
1 2 3 4 5 DK/NA
Q18Utilizes time effectively for maximum performance.
1 2 3 4 5 DK/NA
Q19Monitors performance toward goals.
1 2 3 4 5 DK/NA
Q20Anticipates and prepares for future developments and deadlines.
1 2 3 4 5 DK/NA
Supervisory Skills
1=Strongly Disagree  2=Disagree  3=Neither Agree nor Disagree   4=Agree  5=Strongly Agree
DK/NA = Don't Know or Not Applicable
Q21Accurately appraises the strengths and weaknesses of others.
1 2 3 4 5 DK/NA
Q22Creates conditions for people to grow and achieve.
1 2 3 4 5 DK/NA
Q23Effectively addresses disciplinary or performance issues in her department.
1 2 3 4 5 DK/NA
Q24Accepts responsibility for the communication of and compliance with Organization programs, policies, rules and regulations.
1 2 3 4 5 DK/NA
Teamwork
1=Strongly Disagree  2=Disagree  3=Neither Agree nor Disagree   4=Agree  5=Strongly Agree
DK/NA = Don't Know or Not Applicable
Q25Demonstrates a willingness to support and contribute to team objectives.
1 2 3 4 5 DK/NA
Q26Displays the ability to motivate and positively influence others internally and externally.
1 2 3 4 5 DK/NA
Q27Has the group process skills needed to get diverse groups of people working together effectively to achieve a common goal.
1 2 3 4 5 DK/NA
Q28Fosters an environment that supports and values teamwork.
1 2 3 4 5 DK/NA
Q29Works effectively with people over whom she has no direct authority.
1 2 3 4 5 DK/NA
Self Management
1=Strongly Disagree  2=Disagree  3=Neither Agree nor Disagree   4=Agree  5=Strongly Agree
DK/NA = Don't Know or Not Applicable
Q30Demonstrates high personal work standards.
1 2 3 4 5 DK/NA
Q31Has integrity; trustworthy.
1 2 3 4 5 DK/NA
Q32Learns from mistakes.
1 2 3 4 5 DK/NA
Q33Makes needed adjustments in own behavior.
1 2 3 4 5 DK/NA
Q34 Overall, what are Janet's three greatest strengths?

A.
B.
C.
Q35 Overall, what three changes would you like to see in Janet's practices that would increase her effectiveness?

A.
B.
C.
Please review to determine if you have answered all of the questions.  The survey program will automatically prevent the submission of partially completed surveys.  If you feel that you cannot complete the survey to your satisfaction at this time, close your browser and begin anew at your convenience before the close of work on May 20.

After pressing the "Submit" button, if your form is complete (no further questions requiring attention), a screen will appear stating that your submission has been received and is being processed.  Once this screen appears, please, DO NOT press the button again!  

  Thank you for your feedback.  


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