OMB Approved:
No. 3206-0252
Public Burden Statement:
We estimate this form takes an average of 15 minutes to complete including the time for getting the needed data and reviewing both the instructions and completed form. Send comments regarding our estimate or any other aspect of this form, including suggestions for reducing completion time, to the Office of Personnel Management (OPM), Assessment Services, Alexis Adams-Shorter (3206-0252),
1900 E. Street N.W., Washington, DC 20415-7900. The OMB Number, 3206-0252, is currently valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed.
This survey consists of five parts: Part I – Organizational Experiences, Part II – Personal Experiences,
Part III – Agency Specific Items, Part IV – Background and Employment Information, and Part V – Comment Section.
Part I – Organizational Experiences
Describe the conditions in the organization where you work. The items ask for your overall impression of how things are in your organization. You should consider the experiences of others, as well as your own experiences. Respond to these items based on the level in your organization that is appropriate for the content of the item. Depending on how your organization is structured, this could either be your own work unit, or one or two levels above your own.
Describe only your own work experiences or your personal opinions/attitudes about various aspects of your job.
Part III – Agency Specific Items
Describe your experiences with respect to specific organizational issues/concerns.
Describe your background and employment status. Your answers to these items will help us look at survey results by subgroups.
Part V – Comment Section
Provide your comments on issues you think are relevant.
Several items refer to managers, supervisors, team leaders, or customers. Use the following definitions when answering items referring to these terms.
Managers: |
All levels of management above first-line supervisor. |
Supervisors: |
First-line supervisors; typically those who are responsible for employees' performance appraisals and approval of their leave. |
Team Leaders: |
Not official supervisors; those who provide employees with day-to-day guidance in conducting work projects, but do not have supervisory responsibilities or conduct performance appraisals. |
Customers: |
Anyone who uses or receives the products or services that your organization provides; may include individuals within your organization and individuals outside your organization. |
When answering the items in the survey, please darken the circle corresponding to the response you choose. Please read each item carefully and answer in a frank and honest manner. It takes approximately 20 – 30 minutes to complete the entire survey. Your responses to this survey are anonymous. Your responses will be combined with others in your organization to create summary reports.
Privacy Act: In accordance with Public Law 93-579 (Privacy Act of 1974) the providing of personal information is completely voluntary. Collection of this information is authorized by Sections 4702 of Title 5, US Code. |
Do not reproduce, store in a retrieval system, or transmit in any form or by any means (including, without limitation, electronic, mechanical, or through the use of photocopying or recording equipment), any part of this survey instrument without written permission from the Division for Human Resources Products and Services, U.S. Office of Personnel Management. Any such action taken without such permission is unauthorized
PART I – ORGANIZATIONAL EXPERIENCES
The following items ask you to describe your organizational experiences in [Agency Name]. Using the scale below, indicate the extent to which you agree or disagree with each of the following statements.
Please use the “Do Not Know” response only if you feel you do not have enough information to answer the item accurately.
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Strongly Disagree |
Disagree |
Neither Disagree nor Agree |
Agree |
Strongly Agree |
Do Not Know |
Leadership and Quality |
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Training/Career Development |
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Strongly Disagree |
Disagree |
Neither Disagree nor Agree |
Agree |
Strongly Agree |
Do Not Know |
Innovation |
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Customer Orientation |
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Fairness and Treatment of Others |
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Strongly Disagree |
Disagree |
Neither Disagree nor Agree |
Agree |
Strongly Agree |
Do Not Know |
Communication |
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Employee Involvement |
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Use of Resources |
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Strongly Disagree |
Disagree |
Neither Disagree nor Agree |
Agree |
Strongly Agree |
Do Not Know |
Rewards and Recognition |
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Work Environment |
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Work and Family/Personal Life |
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Strongly Disagree |
Disagree |
Neither Disagree nor Agree |
Agree |
Strongly Agree |
Do Not Know |
Teamwork |
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Readiness to Reshape Workforce |
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Strategic Planning |
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Strongly Disagree |
Disagree |
Neither Disagree nor Agree |
Agree |
Strongly Agree |
Do Not Know |
Performance Measures |
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Diversity |
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Strongly Disagree |
Disagree |
Neither Disagree nor Agree |
Agree |
Strongly Agree |
Do Not Know |
Supervision |
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PART II – PERSONAL EXPERIENCES
The following items ask you to describe your personal experiences in [Agency Name].
Personal Experiences
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Strongly Disagree |
Disagree |
Neither Disagree nor Agree |
Agree |
Strongly Agree |
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Very Poor |
Poor |
Fair |
Good |
Very Good |
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Much Lower |
Slightly Lower |
About the Same |
Slightly Higher |
Much Higher |
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Far Too Little |
Too Little |
About Right |
Too Much |
Far Too Much |
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One of the Worst |
Below Average |
About Average |
Above Average |
One of the Best |
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Yes |
No |
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For items 101-107 please indicate how satisfied you are with:
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Very Dissatisfied |
Dissatisfied |
Neither Dissatisfied nor Satisfied |
Satisfied |
Very Satisfied |
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Very Dissatisfied |
Dissatisfied |
Neither Dissatisfied nor Satisfied |
Satisfied |
Very Satisfied |
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PART III – AGENCY SPECIFIC ITEMS
The following items ask you to describe your experiences with respect to specific organizational issues/concerns.
Agency Specific Items
PART IV – BACKGROUND AND EMPLOYMENT INFORMATION
The following items ask about your background and employment status. Your answers to these items will help us look at survey results by subgroups – for example, supervisors and non-supervisors, males and females. Responses will NOT be used to identify individual respondents.
How long have you been a Federal government employee (excluding military service)?
Less than six months
Six months to less than one year
One to three years
Four to five years
Six to 10 years
11 to 15 years
16 to 20 years
21 to 25 years
26 to 30 years
31 years or more
How long have you been with [Agency Name]?
Less than six months
Six months to less than one year
One to three years
Four to five years
Six to 10 years
11 to 15 years
16 to 20 years
21 to 25 years
26 to 30 years
31 years or more
Where do you work at [Agency Name]?
Organization A
Organization B
Organization C
Organization D
Organization E
Organization F
Organization G
Organization H
Organization I
Organization J
Organization K
What is your job category?
Professional (for example, scientist, engineer, psychologist, attorney, etc.)
Administrative (for example, personnel mgmt, budget, contracting, procurement specialist, etc.)
Technician
Clerical (for example, support staff, executive secretary, etc.)
Blue Collar
Other
What is your pay category?
General Schedule and similar (GS, GG, GW, GN,GM, GH)
Demonstration/Alternative Pay Systems
Senior Executive Service (SES)
Federal Wage System (WG, WL, WS)
Senior Level (SL, ST)
Administrative Law Judge (SES)
Title 38 (VA, Veterans Health Administration)
What is your pay grade? (if under pay band, proceed to the next item.)
1-4
5-8
9-12
13-15
SES
What is your pay band level?
N/A
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II
III
IV
V
VI
What is your level of supervisory responsibility?
None
Team leader
First-line supervisor
Manager
Executive
What is your age?
Less than 20
20-29
30-39
40-49
50-59
60 or over
Are you male or female?
Male
Female
Are you of Hispanic or Latino origin?
Yes
No
What is your race?
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White
PART V – COMMENT SECTION
Please use the following space to describe what your organization is doing well. Responses to this item will be aggregated and reported to your agency leadership. Please do not include any information that could identify a particular individual, including yourself.
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Please use the following space to describe what you would like to see your organization change. Responses to this item will be aggregated and reported to your agency leadership. Please do not include any information that could identify a particular individual, including yourself.
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File Type | application/msword |
File Title | Organizational Assessment Survey |
Author | Kimya S. Lee |
Last Modified By | Pierce, Steven |
File Modified | 2014-02-20 |
File Created | 2009-05-08 |