Survey Number: I Facility Name:
Date in Ethiopian Calendar How long have you worked Inthis Facility?
DD MM yyyy Years Months
Job Category (please check one box_Q..!!!.YI:
Medical Doctors & Dental (Physician,GP,all
specialists,etc.) Nurse and Midwife (all specialist nurses)
Other Health Professional (Laboratory staff,pharmacy staff,physiotherapy etc.)
Management and Administration (Finance,HR, Secretary, Registration Room
workers,etc.) Other Support Staff (Cleaners,Kitchen Staff, Guards, Laundry staff,runners,
drivers, etc.)
Strongly Strongly
Disagree Agree
Disagre Agree
1. The management of this organization is supportive of me.
e ,o 20 30 ,o
2. Ireceive the right amount of support and guidance from my direct superv isor.
,o 20 30 ,o
3. Iam provided with all trainings necessary for me to perform myjob.
,o 20 30 ,o
4. Ihavelearned many new jobskills in this position.
,o 20 30 ,o
5. Ifeel encouraged by my supervisor to offer suggestions and improvements.
,o 20 30 ,o
6.The management makes changes based on my suggestions and feedback.
,o 20 30 ,o
7. Iam appropriately recognized when Iperform well at my regular work duties
,o 20 30 ,o
8. The organization rules make it easy for me to do a good job.
,o 20 30 ,o
9. Iam satisfied with my chances for promotion.
,o 20 30 ,o
10. Ihave adequate opportunities to develop my professional skills.
,o 20 30 ,o
11. Ihave an accurate written job description.
,o 20 30 ,o
12. The amount of wor k Iam expected to fin ish each week ,o 20 30 ,o
is reasonable.
13. My work assignments are always clearly explained to me.
,o 20 30 ,o
14. My work is evaluated based on a fair system of performance standards.
,o 20 30 ,o
15. My department provides all the equipment, supplies, and ,o 20 30 ,o
resources necessary for me to perform my duties
16. The buildings, grounds and layout of this facility are adequate for ,o 20 30 .o
me to perform my work duties.
17. My coworkers and Iwork well together.
,o 20 30 ,o
18. Ifeel Ican easily communicate with members from all levels of ,o 20 30 ,o
this organization.
Definitely Probably Probably Definitely
19. Iwould recommend this health facility to other workers as a good No No Yes Yes
place to work. ,o ,o ,o ,o
20. How would you rate this health facility as a place to work on a scale of
0 0 0 0 0 0 0 0
0 0
1(the worst) to 10 (the best)? 1 2 3 4 5 6 7 8 9 1D
Worst .....................................................Best