This survey can help in feedback of employees, and help you figure out whatneeds issues need to be addressed and fixed within the company.
Section 1: Your Feelings about [name of company]
How likely are you to be working at [company] two years from now?
- Strongly Agree
- Very Likely
- Somewhat Likely
- Not Very Likely
- Not at All Likely
How much do you agree or disagree that…
I really feel like part of the family at [company]?
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
I am proud to work for [company]?
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
I feel a strong personal attachment to [company]?
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
When [company] has problems, I think of them as my problems too?
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
Section 2: Your Relationship with [company]
Use this scale to show how much you agree or disagree that…
a. Customers can rely on [company] to deliver outstanding quality, service,and value.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
b. [company] values my relationship, really cares about me, and invests in mysuccess.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
c. [company] attracts and retains outstanding employees and partners.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
d. [company] sets the standard for excellence in its industry.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
e. [company] communicates openly and honestly.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
f. [company] is committed to win/win solutions and will not profit at theexpense of partners or customers.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
g. [company] listens well and responds quickly to feedback.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
h. I would like to see my relationship with [company] grow in the foreseeablefuture.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
i. I understand the values and principles that guide [company] leadership.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
j. I provide enthusiastic referrals for [company].
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
k. I trust [company] leaders to behave with fairness and integrity.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
l. I understand our strategy and the role I must play for our success.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
m. [company] has a winning strategy (superior economics in serving ourcustomers).
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
n. [company] focuses all of its energy and resources in areas where it can bethe best.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
o. I always know where I stand with [company].
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
p. [company] has sufficient opportunities to grow its business.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
q. [company] provides me with the information I need to make good decisions.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
r. [company] involves the right people in decisions and then takes actionquickly.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
s. Employee loyalty is appropriately valued and rewarded at [company].
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
t. At [company], we keep organizational structure simple by utilizing smallteams.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
u. People are fairly rewarded for their contributions to [company]’s longterm success.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
v. Leaders respect my time and help me manage my time effectively.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
w. [company] treats me like a real partner.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
x. Customer loyalty is appropriately valued and rewarded at [company].
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
y. I believe that [company] deserves my loyalty.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
z. Over the past year, my loyalty to [company] has grown stronger.
- Strongly Agree
- Agree
- Neither Agree nor Disagree
- Disagree
- Strongly Disagree
How would you rate the overall quality of the products and services providedby [company]?
- Excellent
- Very Good
- Good Fair
- Poor
What is the single improvement that [company] could make to increase yourloyalty to it?
________________________________________________
________________________________________________
Section 3: Descriptive Information
This last part may help you divide people into groups.
How long have you been an employee of [company]?
- Less than one year
- One to under three years
- Three to under five years
- Five to under ten years
- Ten years or more
At what location do you work?
- Corporate/administrative headquarters
- Field
What is your position?
- Executive/upper management
- Middle management
- Supervisor
- Individual contributor
This material is used by permission of Bain & Company from Loyalty Rules!How Today’s Leaders Build Lasting Relationships, by Frederick Reichheld,Copyright 2001, Harvard Business SchoolPublishing.
