Civilitas: Psychological Safety Survey
Please share your CONFIDENTIAL responses to the following questions.
The goal of the Civilitas program is to empower and encourage every team member to contribute freely and regularly; being able to exercise the very best version of who they are.
1.
Please choose which organization/location/department you're a team member of:
XXX
XXX
Other (please specify)
2.
Please share your responses to the following questions:
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Agree Strongly
If you make a mistake on this team, it is often held against you.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Agree Strongly
Members of this team are able to bring up problems and tough issues.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Agree Strongly
People on this team sometimes reject others for being different.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Agree Strongly
It is safe to take a risk on this team.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Agree Strongly
It is difficult to ask other member of this team for help.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Agree Strongly
No one on this team would deliberately act in a way that undermines my efforts.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Agree Strongly
Working with members of this team, my unique skills and talents are valued and utilized.
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Agree Strongly
3.
Overall Comments: