Personal Accountability Questionnaire

Name*
First Last
Email Address*
Telephone
1. To what degree do you achieve your performance goals on time with a high level of quality and customer satisfaction?*
Low 1 2 3 4 5 6 7 8 9 10 High
2. To what degree do you openly share information in a timely manner without over-sharing information or only sharing information on request?*
Low 1 2 3 4 5 6 7 8 9 10 High
3. To what degree do you freely support others within or outside of your team whether asked or not?*
Low 1 2 3 4 5 6 7 8 9 10 High
4. To what degree do you surface an issue directly with another person in a timely manner for resolution without talking behind their backs or ignoring them?*
Low 1 2 3 4 5 6 7 8 9 10 High
5. To what degree do you take ownership when a problem occurs and find a solution rather than blaming others?*
Low 1 2 3 4 5 6 7 8 9 10 High
6. To what degree do you seek out more responsibility and volunteer for tasks outside of your job description rather than only doing the minimal requirement?*
Low 1 2 3 4 5 6 7 8 9 10 High
7. To what degree do you surface problems in a timely manner with suggested solutions rather than complain or wait until it turns into a crisis?*
Low 1 2 3 4 5 6 7 8 9 10 High
8. To what degree do you talk positively about your team and others outside of your team, management and the organization as a whole?*
Low 1 2 3 4 5 6 7 8 9 10 High
9. To what degree do you compliment your teammates, management and others outside of your team for their efforts, achievements and positive attitude*
Low 1 2 3 4 5 6 7 8 9 10 High
10. To what degree are you committed to personal and professional development and making changes as opposed to resisting change?*
Low 1 2 3 4 5 6 7 8 9 10 High
What is your industry?*
- Aerospace-Defense
- Education
- Energy-Environment
- Financial-Insurance
- Food-Beverage
- Government-Nonprofit
- Healthcare
- High Tech
- Manufacturing
- Media-Entertainment
- Pharmaceuticals-Biotech
- Retail
- Services
- Telecommunications
- Transportation
- Wholesale-Distribution
What is your role?*
- Executive
- Manager
- Supervisor
- Project Leader
- Individual Contributor
Please enter your age*
- 18 - 30
- 31 - 40
- 41 - 50
- 51 - 60
- 61+
Please enter your gender*
- Male
- Female

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