1 Which of the following best describes the department you work in? *

Customer Service  Finance  Sales & Marketing  Information Technology  Human Resources  Corporate Relations

2 Which of the following best describes your position here? *

Staff  Manager  Senior Manager

3 How long have you worked at (Company)?

SELECT ONE Less than a year 1-2 years 3-5 years 6-9 years More than 10 years

4 What is your view of the company?

5 Please indicate your level of agreement with each of the following statements.

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
If I do a good job I will be rewarded
I get what I need to do my job well
The conditions I work in are good
I feel stress in my job
I am interested in my job
Management makes wise decisions
I am proud to work for this company

6 Do you feel that employees are recognized as individuals?

Always  Usually  Sometimes  Rarely  Never

7 How motivated are you to see the company succeed?

SELECT ONE Very motivated Somewhat motivated Not very motivated Not at all motivated Not sure

8 How often would you say the company communicates its goals and strategies to you?

SELECT ONE Always Usually Sometimes Never Not Sure

9 Have you ever experienced any of the following forms of discrimination or harassment at this company?

Racial discrimination Sexual harassment Age discrimination Gender discrimination Sexual orientation discrimination Other (please specify)

10 This company tries to create an exciting work environment?

Strongly Agree	Agree	Don't know	Disagree	Strongly Disagree

11 I receive a sense of completion with my job?

Yes	No	Don't know

13 How would you rate (Company) on each of the following?

	Excellent	Good	Fair	Poor
Health Care
Holidays
Training Availability
Performance Reviews
Day Care
Parking
Retirement Plan
Salary/Wages

14 On a scale of 1 to 5, where 1 means not at all clear and 5 means very clear, how clear are your job requirements to you?

SELECT ONE 1 - Not at all clear 2 3 4 5 - Very Clear

15 Please supply us with your contact information. *

Name
Department
Address
E-Mail
Telephone

16 Please give any suggestions on how to improve any aspect of the company.