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Example of PQA's
On-line Survey Forms

The following form is provided as an example of the on-line employee survey form developed and administered by PQA for various clients.

These types of surveys are useful for use with employees, customers, suppliers, distributors, service personnel, neighbours (ie. ISO 14001 Environmental Aspects survey), and similar groups.

PQA will work with the client to design a custom survey that exactly meets the client's needs.  Alternatively, the client can choose one of PQA's standard templates at a reduced cost (no changes, additions, nor deletions are permitted to standard templates).

For the e-mail addresses provided by the client, PQA will e-mail them the Internet link to the on-line survey form and their Unique Key.  Alternatively, PQA can prepare letters in sealed envelopes that can be chosen at random by the survey participants.

Once the survey data is received by PQA's web server, it is stored under secure conditions.  When all the data has been received, the survey data is statistically analyzed for maximum understanding and usefulness.

A formal report with numerous colour graphs is produced for the client.  If requested, PQA can provide additional consulting or implementation services to assist the client in receiving maximum value from the survey.

Typically, PQA recommends that management receive conclusions and recommendations on the following:

  • Greatest Priority or Importance.  These are the issues that management must take special care with as they form the basis for corporate culture and/or trust.
     
  • Greatest Concerns or Dis-satisfaction.  These are the action items for management to change.
     
  • Greatest Satisfaction.  These are the issues that should be celebrated and used to remind all participants about past achievements.
     
  • Greatest Controversy, dis-agreement, or mis-understanding amongst survey participants.  These are areas for management to investigate further, and possibly provide opportunities for further training (or consensus building) prior to taking further action.
     
  • PQA's Conclusions and Recommendations   Based on the survey participant's overall satisfaction scores, answers, and demographic factors (age, Department, job, years of service, work site, etc.), PQA does complex statistical regression and factor analysis for prediction of optimum policies and conditions for achieving maximum satisfaction and/or results.

A typical survey that was custom designed for a particular client is as follows.  Your survey will be different.

The following survey form, questions, arrangement, look, and feel are trademarks, copyrighted, and designs owned by PQA.  All rights reserved.  Nobody is authorized to use these examples for any purpose, nor to make derivative works there from.
 

 

 

 

 

Your company logo goes here
for
 Company "XXX"

 

 

XXX Employee Survey

With your ideas & input, we can focus our improvement effort on what matters most to you, and XXX.

This survey will take you 6 minutes, plus the time to type in your additional comments (if any).

Below are 25 questions on the various aspects of your employment experience at XXX.

We appreciate your time and ideas to assist us in continuous improvement of XXX.

Process Quality Associates Inc. is a consulting company specializing in quality assurance and business excellence, and are conducting the survey on XXX' behalf.
 

YYYY YYYY, President of XXX
&
Glenn Black, Survey Project Manager for Process Quality Associates Inc.

Please enter your Survey Unique Key:

Note:  Your survey will not be processed without this exact Key value provided you.  Since you randomly chose this Key from all the ones made available by PQA, nobody is able to use this Key to identify you, nor your answers.  If you have an Internet failure, or wish to re-start the survey, you can re-submit your answers using this same Key.  If there is more than one submission for a particular Key, PQA will only use the last, complete submission by each authorized Key.

1.   Overall, I enjoy my job and coming to work at XXX.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
2.   At XXX, my opinions are listened to, and count for something.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
3.   I am respected and appreciated by my XXX Supervisor/Team Leader.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
4.   I speak up about problems, opportunities, changes, and other work issues at XXX.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
5.   I’ve received the necessary information and training to do my job well at XXX.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
6.   I’m provided with the tools, materials, equipment, and supplies I need to do my job well.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
7.   I know what is expected from me in my job at XXX. 
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
8.   I receive sufficient recognition or praise when I do good work at XXX.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
9.  I consistently provide excellent customer service while working at XXX.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
10.    I understand the Mission or purpose of XXX.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
11.  My job is important to the Mission of XXX.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
12.  In the last six months, someone at XXX has talked to me about my progress.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
13.   I’m physically and/or mentally exhausted by the end of my work day at XXX.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
14.  I am a valued member of a work team at XXX.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
15.   At XXX, the employees are committed to doing quality work.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
16.  My Supervisor/Team Leader at XXX is a good coache.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
17.   If and when it occurs, my XXX Supervisors/Team Leader reasonably hold employees accountable for their poor performance and lack of effort.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
18.  XXX Supervisors/Team Leaders have clear priorities, consistently stick to them, and ensure they get done.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
19.  I understand XXX’ customers, and their needs.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
20.  Changes at XXX are done in an organized, effective manner.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
21.  XXX treats all employees in a fair, responsible, and professional manner.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
22.  At XXX, everybody puts sufficient priority on prevention and continuous improvement.
Not scored
Strongly agree
Agree
Disagree
Strongly Disagree
Don't know, Not Applicable
Comments to explain why you gave this score, and what XXX could do to improve the score:
23.  What has XXX done that deserves your recognition and praise ?

24.  What suggestions can you make to improve XXX ?  Where should XXX focus its improvement efforts ?

25.  What can you do to help improve your job satisfaction?


So that we can better understand the variations in the survey answers for the various work environments within XXX, please answer the following demographic questions.

NO survey results will be reported to XXX Management where there is less than 4 people in that sub-group, nor when a particular individual could be identified by their answers.
 
26.   What is your gender?
Not scored
Male
Female
Don't know, Not Applicable
27.   What age group are you in?
Not scored
16-18 years old
19-21
22-24
25-34
35-44
45+ years old
28.   How long have you worked at XXX?
Not scored
Less than 1 month
At least 1 month, but less than 3 months
At least 3 months, but less than 12 months
At least 1 year, but less than 3 years
At least 3 years, but less than 5 years
5 years or more
Don't know, Not Applicable
29.   Which XXX department do you currently work in?
Not scored
Department "AAA1"
Department "AAA2"
Department "AAA3"

Don't know, Not Applicable
30.  During the last 3 months, how many hours per week have you been typically working at XXX ?
Not scored
Less than 8 hrs. per week
Between  9 to 17 hrs. per week
Between  18 to 26 hrs. per week
Between  27 to 35 hrs. per week
More than 36 hrs. per week
Don't know, Not Applicable
31.  What is the most correct description of your current formal education ?
Not scored
I have taken some high school courses, but never graduated from high school.
I graduated from high school.

I graduated from high school, and have taken some college or university courses.
I graduated from college or university.
I graduated from college or university, and have taken some Continuing Ed. or post-graduate courses.

Don't know, Not Applicable
32.  Describe your life-long learning status as of today (CHECK ALL THAT APPLY).
I have completed all my formal education, and have no plans for additional education.
I am currently enrolled in one or more full time, part-time, or continuing education course(s) .
During the past 12 months, I was enrolled in one or more full time, part-time, or continuing education course(s).
I currently plan to return to school (either part-time, full-time, or Continuing Ed.) in the fall of this year.
I believe in Life-long Learning, and plan on continually taking courses for the rest of my life.

I hope to be able to do some additional formal education sometime in my future.
Don't know, Not Applicable
Click Button to Send Your XXX Survey Answers to PQA      
(Button is disabled, non-working example)

© 2004   Process Quality Associates Inc.   All rights reserved
PQA Projects/2004/XXXX01_Survey/survey.html
http://pqa.net/surveys/ZZZZ-XXX/survey.html
Original: April 12th, 2004            Current Version: 29         April 27, 2004



           
 

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