Service Excellence Team Building Survey

Thank you for being a part of CSM's Service Excellence program! We're requesting your input to help departments work together more smoothly.

Please be completely open with your responses -- if you choose to include your name, we will keep it anonymous when results are listed.

Please remember to click the "submit answers" button at the bottom of the survey before closing this window. You may be directed back to any mandatory questions that weren't answered.
Name (optional): 


A red asterisk (*) indicates required questions.

  1. Where do you work (name of clinic)?*


  1. Please use the following scale to rate how each statement applies to your work situation:

    4 = Usually
    3 = Sometimes
    2 = Rarely
    1 = Never

    Employees are unguarded and passionate in their discussion of issues.*
    1 2 3 4


  1. 4 = Usually
    3 = Sometimes
    2 = Rarely
    1 = Never

    Employees end discussions with clear and specific agreements or calls to action.*
    1 2 3 4


  1. 4 = Usually
    3 = Sometimes
    2 = Rarely
    1 = Never

    Employees know their peers' roles, and how co-workers contribute to the overall "good of the clinic." *
    1 2 3 4


  1. 4 = Usually
    3 = Sometimes
    2 = Rarely
    1 = Never

    Employees quickly and genuinely apologize to each other when they say or do something inappropriate. *
    1 2 3 4


  1. 4 = Usually
    3 = Sometimes
    2 = Rarely
    1 = Never

    Employees openly admit their weaknesses and mistakes.*
    1 2 3 4


  1. 4 = Usually
    3 = Sometimes
    2 = Rarely
    1 = Never

    Employees state their feelings during meetings, as opposed to afterward during private discussions. *
    1 2 3 4


  1. 4 = Usually
    3 = Sometimes
    2 = Rarely
    1 = Never

    Employees challenge one another about their plans and approaches.*
    1 2 3 4


  1. 4 = Usually
    3 = Sometimes
    2 = Rarely
    1 = Never

    Employees are slow to seek credit for their own contributions, but quick to point out those of others.*
    1 2 3 4


  1. 4 = Usually
    3 = Sometimes
    2 = Rarely
    1 = Never

    Employees are comfortable talking about feelings, problems and successes -- as well as deadlines, tasks and procedures.*
    1 2 3 4





Matt Byrnes