ExecTech Staff Questionnaire
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Name
*
First Name
Last Name
Position
*
Date of Hire
*
Practice Name
*
Who is your Supervisor?
*
Email
*
example@example.com
Cell Phone (Optional)
Please enter a valid phone number.
1. Please describe your job and your duties.
2. What are you greatest work skills?
3. Do you keep track of a production statistic for your job? If so, what is it?
4. Are you given weekly production goals?
5. Do you have a written job description? If so, is it thorough and complete?
6. Have you attended any workshops or seminars for your job? If so, please describe.
7. What do you hope to improve about your performance?
8. What does your boss hope you improve about your performance?
9. To do a better job, what would you like to learn?
10. To do a better job, what must change?
11. Are you satisfied with your pay? If not, please explain.
12. Do you have a bonus plan? If so, how do you like it?
13. Do you receive any other benefits from this practice? If so, please explain.
14. What do you like or dislike about staff meetings?
15. Who is your immediate supervisor?
16. Please describe your working relationship with your supervisor?
17. How could your working relationship with your supervisor improve?
18. Do you supervise other staff members? If so, who?
19. What could improve about your working relationship with the people you supervise?
20. Please use at least three sentences to describe the mood or tone of the office?
21. If you were in charge, what would you change?
22. Of all the people in the practice, who is the most difficult to get along with?
23. Of all the people in the office, who is the easiest to get along with?
24. What is the biggest source of stress in the office?
25. What do patients complain about the most?
26. What could your boss do to help you get more work done?
27. Are you overloaded? If so please describe.
28. If the practice was to increase the flow of new patients by 20%, could you handle the flow without more help? If not, please explain.
29. Could you take on more duties and responsibilities? If so, please explain.
30. If you were assigned more responsibility, would you expect more pay?
31. What are the three most important things you want from this job?
32. What are the three most important things the practice wants from you?
33. Please list three ways this practice could become more productive.
34. Overall, what do you like the least about working here?
35. Overall, what do you like the most about working here?
36. What do you picture yourself doing one year from now?
37. What do you picture yourself doing two years from now?
38. What do you picture yourself doing five years from now?
39. What experience do you have with practice-management companies?
40. In your opinion, what should an excellent consulting company do?
41. What are the first three problems ExecTech should help the practice owner(s) resolve?
42. Do you have any comments or questions?
Thank you very much!
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