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Leadership Survey

Your answers along with your comments, details and suggestions will be kept private and anonymous. Results are not usually shown to evaluees. However, no one will see your name, unless direct conversation is deemed helpful AND you elect to release the name.


To participate, you are required to answer each question.
However, you are not required to enter answers in the boxes provided for either: 1) the "Comments, details and/or suggestion on this point of evaluation, if any. " or the 2) the "What could be done to raise your evaluation, if anything?"
(These boxes are provided for each specific quesiton.)


Your input is critical:
a. If you are interested in having a survey done for you or for someone you know or work with, email me. 
b. If you have any questions about this survey, email me.
c. If you have any additional questions or suggestions on ways to rephrase a question on this survey, email me.
(Whereever appropriate, please refer to a question number.) 

Name of Evaluee (Person being evaluated) *
 Relationship of Evaluee to you *
The evaluee is my leader or coach.  
The evaluee is a member of my team or work group (a peer).  
The evaluee reports to me (I am a manager).  
The evaluee is one of my contractors or vendors.  
01. Is the evaluee honest and straightforward. *
1 - Almost Never   
2 - Seldom  
3 - Sometimes   
4 - Often   
5 - Almost Always  
1. Comments, details and/or suggestion on this point of evaluation, if any.
 1. What could be done to raise your evaluation, if anything?
2. The evaluee expects high levels of performance from others. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
2. Comments, details and/or suggestion on this point of evaluation, if any.
 2. What could be done to raise your evaluation, if anything?
3. The evaluee asks the difficult questions. *
1 - Almost Never  
2 - Seldom  
3 - Sometimes  
4 - Often  
5 - Almost Always  
3. Comments, details and/or suggestion on this point of evaluation, if any.
 3. What could be done to raise your evaluation, if anything?
4.The evaluee seeks feedback. *
1 - Almost Never  
2 - Seldom  
3 - Sometimes  
4 - Often   
5 - Almost Always  
4. Comments, details and/or suggestion on this point of evaluation, if any.
 4. What could be done to raise your evaluation, if anything?
5.The evaluee expresses confidence in others. *
1 - Almost Never  
2 - Seldom  
3 - Sometimes  
4 - Often   
5 - Almost Always  
5. Comments, details and/or suggestion on this point of evaluation, if any.
 5. What could be done to raise your evaluation, if anything?
6.The evaluee engages in thoughtful conversations. *
1 - Almost Never  
2 - Seldom  
3 - Sometimes  
4 - Often  
5 - Almost Always  
6. Comments, details and/or suggestion on this point of evaluation, if any.
 6. What could be done to raise your evaluation, if anything?
7.The evaluee acts consistently with his or her stated values. *
1 - Almost Never  
2 - Seldom  
3 - Sometimes   
4 - Often  
5 - Almost Always  
7. Comments, details and/or suggestion on this point of evaluation, if any.
 7. What could be done to raise your evaluation, if anything?
8.The evaluee reminds others of their unique strengths and talents. *
1 - Almost Never  
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
8. Comments, details and/or suggestion on this point of evaluation, if any.
 8. What could be done to raise your evaluation, if anything?
9.The evaluee seeks the underlying causes of problems. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
9. Comments, details and/or suggestion on this point of evaluation, if any.
 9. What could be done to raise your evaluation, if anything?
10. The evaluee acts with humility. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
10. Comments, details and/or suggestion on this point of evaluation, if any.
 10. What could be done to raise your evaluation, if anything?
11.The evaluee demonstrates courage in confronting the truth. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
11. Comments, details and/or suggestion on this point of evaluation, if any.
 11. What could be done to raise your evaluation, if anything?
12.The evaluee helps others gain new perspectives. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
12. Comments, details and/or suggestion on this point of evaluation, if any.
 12. What could be done to raise your evaluation, if anything?
13.The evaluee accepts responsibility for his or her mistakes. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
13. Comments, details and/or suggestion on this point of evaluation, if any.
 13. What could be done to raise your evaluation, if anything?
14.The evaluee expects others to continually improve their performance. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
14. Comments, details and/or suggestion on this point of evaluation, if any.
 14. What could be done to raise your evaluation, if anything?
15.The evaluee encourages innovative solutions. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
15. Comments, details and/or suggestion on this point of evaluation, if any.
 15. What could be done to raise your evaluation, if anything?
16.The evaluee relates well to others. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
16. Comments, details and/or suggestion on this point of evaluation, if any.
 16. What could be done to raise your evaluation, if anything?
17.The evaluee questions the status quo. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
17. Comments, details and/or suggestion on this point of evaluation, if any.
 17. What could be done to raise your evaluation, if anything?
18.The evaluee promotes breakthrough thinking. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
18. Comments, details and/or suggestion on this point of evaluation, if any.
 18. What could be done to raise your evaluation, if anything?
19.The evaluee helps others excel. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
19. Comments, details and/or suggestion on this point of evaluation, if any.
 19. What could be done to raise your evaluation, if anything?
20.The evaluee challenges others to take personal responsibility for their performance. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
20. Comments, details and/or suggestion on this point of evaluation, if any.
 20. What could be done to raise your evaluation, if anything?
21.The evaluee expects others to invest in their future. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
21. Comments, details and/or suggestion on this point of evaluation, if any.
 21. What could be done to raise your evaluation, if anything?
22.The evaluee sacrifices his or her interests for the success of others. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
22. Comments, details and/or suggestion on this point of evaluation, if any.
 22. What could be done to raise your evaluation, if anything?
23.The evaluee encourages others to find their own unique solutions. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
23. Comments, details and/or suggestion on this point of evaluation, if any.
 23. What could be done to raise your evaluation, if anything?
24.The evaluee facilitates action planning. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
24. Comments, details and/or suggestion on this point of evaluation, if any.
 24. What could be done to raise your evaluation, if anything?
25.The evaluee demonstrates that he or she cares deeply for others. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
25. Comments, details and/or suggestion on this point of evaluation, if any.
 25. What could be done to raise your evaluation, if anything?
26.The evaluee holds others accountable. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
26. Comments, details and/or suggestion on this point of evaluation, if any.
 26. What could be done to raise your evaluation, if anything?
27.The evaluee has a bias for action. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
27. Comments, details and/or suggestion on this point of evaluation, if any.
 27. What could be done to raise your evaluation, if anything?
28.The evaluee treats others with dignity and respect. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
28. Comments, details and/or suggestion on this point of evaluation, if any.
 28. What could be done to raise your evaluation, if anything?
29.The evaluee promotes partnerships *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
29. Comments, details and/or suggestion on this point of evaluation, if any.
 29. What could be done to raise your evaluation, if anything?
30.The evaluee makes time to have important conversations. *
1 - Almost Never   
2 - Seldom   
3 - Sometimes   
4 - Often   
5 - Almost Always  
30. Comments, details and/or suggestion on this point of evaluation, if any.
 30. What could be done to raise your evaluation, if anything?
Your Name
Your Name will be held anonymously, if you check the box below. *
 Would you like your name to be anonymous? *
YES! Please keep my name private and anonymous.  
It is OK to share my name.  
Your City and State *

* Required to submit this form



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