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What is your gender?
 
Male
 
Female
 
 
 
How long have you worked for (Company)?
 
Less than 3 months
 
3 months - 1 year
 
1 - 3+ years
 
4 - 6+ years
 
7 - 10+ years
 
10+ years
 
 
 
What category BEST describes your job?
 
Officer/Director/Manager/Supervisor
 
Professional (salaried non-mgt. business & technical)
 
Technical (hourly)
 
Sales Reps
 
Administrative Support
 
Customer Service
 
Other
 
 
 
 
Please indicate your level of agreement with each of the following:
 
 
 
Very   
satisfied   
Somewhat   
satisfied   
Neutral     Somewhat  
dissatisfied    
Very    
dissatisfied    
N/A
Salary
Benefits
Frequency and amount of bonuses
Connection between pay and performance
Security and administration of your 401(k)/stock options/pension plans
Workload
Flexibility of work hours
Physical working environment
Opportunity for advancement
Job security
Very   
satisfied   
Somewhat   
satisfied   
Neutral     Somewhat  
dissatisfied    
Very    
dissatisfied    
N/A
Ability to influence decisions that affect you
Ability to influence day-to-day company success
Opportunity to use new technologies
Opportunity to work on interesting projects
Access to company-sponsored training and seminars
Communication with your supervisor
Recognition received from your supervisor
Your supervisor's management capabilities
Your supervisor's active involvement in your career development
Your overall relationship with your supervisor
Your relationship with your peers
Your relationship with customers/clients/end users
Your understanding of the business mission
Your overall satisfaction with your company
Overall satisfaction with your job
 
 

How likely are you to do the following within a given year?
Strongly   
agree   
Agree    Neutral    Disagree    Strongly   
disagree   
N/A
Choose to miss work because there are other things you would rather do
Choose to miss work because you don’t feel like going
Choose to miss work because you needed the time off but didn’t have enough vacation time
Choose to miss work because you didn’t complete assigned tasks
Choose to miss work because you didn’t want to see your manager
Choose to miss work because you didn’t want to see your co-workers
Choose to miss work because you didn’t feel well
Choose to miss work because you needed a mental break
Choose to miss work because you are looking for a different job and/or interviewing for another company
 
 
 
How many days of work have you missed in the last year?
 
Zero to One
 
Two to Three
 
Four to Five
 
Six to Seven
 
Eight to Nine
 
Ten or More
 
 
 
On average, how many days of work do you miss each year?
 
Zero to One
 
Two to Three
 
Four to Five
 
Six to Seven
 
Eight to Nine
 
Ten or More
 
 
 
How many times per year do you show up to work late or leave early?
 
Zero to Five
 
Six to Ten
 
Eleven to Fifteen
 
Sixteen to Twenty
 
More than Twenty