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Chapter1or2-SampleSurvey-JobSatPerformance.doc
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EMPLOYEE PORTION OF SURVEY

Attitudes About Your Job

Instructions: The following set of questions relate to attitudes about your job. Please read the question. Then, circle the number that corresponds to your level of agreement with the statement, using a scale of 1 to 7, with 1 meaning that you “Strongly Disagree” with the statement and 7 meaning that you “Strongly Agree” with the statement.

Strongly Disagree

Disagree

Slightly Disagree

Neutral

Slightly Agree

Agree

Strongly Agree

Job Strain

a) My job tends to directly affect my health.

1

2

3

4

5

6

7

b) I work under a great deal of tension.

1

2

3

4

5

6

7

c) I have felt fidgety or nervous as a result of my job.

1

2

3

4

5

6

7

d) If I had a different job, my health would probably improve.

1

2

3

4

5

6

7

e) Problems associated with my job have kept me awake at night.

1

2

3

4

5

6

7

f) I have felt nervous before attending meetings in the company.

1

2

3

4

5

6

7

g) I often “take my job home with me” in the sense that I think about it when doing other things.

1

2

3

4

5

6

7

Job Satisfaction

h) All in all, I am satisfied with my job.

1

2

3

4

5

6

7

i) In general, I don’t like my job.

1

2

3

4

5

6

7

j) In general, I like working here.

1

2

3

4

5

6

7

Intent to Leave Organization

k) I often think about quitting this job.

1

2

3

4

5

6

7

l) I will probably look for a new job in the next year.

1

2

3

4

5

6

7

SUPERVISOR PORTION OF SURVEY

Performance

Instructions: Below are 6 statements that are related to the dimensions of many company performance reviews. Thinking about your employee’s last performance appraisal, circle the number that most closely reflects how you rated each of the same 3 employees. Please mark the last 4 digits of their social security # .

Very Poor

Out-standing

1

2

3

4

5

6

7

Performance -

Employee #1:

Last 4 digits of

SS#____________

Employee #2:

Last 4 digits of

SS#____________

Employee #3:

Last 4 digits of

SS#____________

a) Ability to work independently.

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

b) Ability to work cooperatively.

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

c) Ability to solve problems.

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

d) Motivation to work hard.

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

e) Potential for promotion.

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

f) Overall performance.

1 2 3 4 5 6 7

1 2 3 4 5 6 7

1 2 3 4 5 6 7

Demographics

The remaining questions are for statistical purposes only. We assure you that you will not be identified using this data. We are simply looking for patterns in the data and comparisons of our sample to the U.S. population.

1) On average, how many hours do you work per week? #______

2) At your primary place of employment, are you considered full-time or part-time? Full time – 1 Part time – 2

3) How many years and months have you been with the organization? Years ______ Months ______

4) Over the course of your tenure with this organization, how many promotions have you received? #______

5) How many persons report to you? #_______

6) What is your gender? Male – 1 Female – 2

7) What is your age? # _______

8) What is your ethnic background?

White …………………………………..1

Asian …………………………….. 4

Black or African American ……………2

Pacific Islander ……………………5

American Indian or Alaska Native …... 3

Hispanic……………………………6

Other (specify)_______________...7

9) What is the highest level of education you have attained?

Some high school ……………………..1

College Graduate ………………….. 4

High School Graduate ….. ……………2

Graduate School ……………………5

Some college …………………….…... 3

10) What is your APPROXIMATE level in your organization?

Top management …………………………….…1

Upper management ……………………………. 2

Middle management…………………………..…3

Staff / Associate level……………………………4

Entry level…………………………………….…5

Professional (accountant, lawyer, doctor, etc.) …6

Other (please specify) ___________________....7

11) Approximately what is your current annual salary before taxes? (Circle one number below.) (Note: This is NOT a household income question.)

Under $15,000………..01

$45,000 - $54,999……..05

$85,000 - $94,999……..09

$15,000 - $24,999…….02

$55,000 - $64,999……..06

$95,000 - $114,999……10

$25,000 - $34,999…….03

$65,000 - $74,999……..07

$115,000 - $124,999…..11

$35,000 - $44,999…….04

$75,000 - $84,999……..08

$125,000 or more……...12

12) How would you classify your industry? (Circle all that apply.)

Agriculture, forestry, fishing and hunting, and mining 1

Finance, insurance, real estate, and rental and leasing 8

Construction 2

Professional, scientific, management, administrative, and waste management services 9

Manufacturing 3

Educational, health, and social services 10

Wholesale trade 4

Arts, entertainment, recreation, accommodation, and food services 11

Retail trade 5

Public administration 12

Transportation and warehousing, and utilities 6

Other services (please specify) _______________________ 13

Information 7

13) How many months and years have you been in this industry? Years ______ Months _______

14) What is your name (for matching purposes only)? ________________________________

Thank you for your time!! We sincerely appreciate it!