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Organizational Health Self-Assessment Questionnaire© by Jeff Pearson and Peter Baverso. All rights reserved. Rev 3. 12/14
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UOP OHSAv3

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UOP OHSAv3

  1. 1. Organizational Health Self-Assessment Questionnaire© by Jeff Pearson and Peter Baverso. All rights reserved. Rev 3. 12/14 Completing the following scorecard will provide you with a snapshot of the health of your organization. DIRECTIONS: Rate each statement using the following scale: ① Strongly Disagree ② Disagree ③ Somewhat Agree ④ Agree ⑤ Strongly Agree – add your total and enter it in the box at the bottom. Compare your score with those in the table. 1. I feel safe at work and I am not afraid to ask for help. ① - ② - ③ - ④ - ⑤ 2. People trust each other and trust is earned. ① - ② - ③ - ④ - ⑤ 3. People do what is right no matter what. ① - ② - ③ - ④ - ⑤ 4. People are willing to make mistakes. ① - ② - ③ - ④ - ⑤ 5. People grow and develop together. ① - ② - ③ - ④ - ⑤ 6. People connect with each other. ① - ② - ③ - ④ - ⑤ 7. People are energized and present. ① - ② - ③ - ④ - ⑤ 8. People strive for simplicity and clarity in communication. ① - ② - ③ - ④ - ⑤ 9. My organization cares about its people. ① - ② - ③ - ④ - ⑤ 10. My organization exhibits compassion. ① - ② - ③ - ④ - ⑤ 11. My organization is adaptive and responsive. ① - ② - ③ - ④ - ⑤ 12. My organization demonstrates unity of purpose. ① - ② - ③ - ④ - ⑤ 13. My organization supports collaboration and innovation. ① - ② - ③ - ④ - ⑤ 14. My organization provides technologies that support collaboration. ① - ② - ③ - ④ - ⑤ 15. My organization encourages relationship building, internally and externally. ① - ② - ③ - ④ - ⑤ 16. My organization encourages learning and sharing. ① - ② - ③ - ④ - ⑤ 17. My organization encourages teams to self-organize and work without boundaries. ① - ② - ③ - ④ - ⑤ 18. My organization demonstrates agility. ① - ② - ③ - ④ - ⑤ 19. I feel optimistic about the future. ① - ② - ③ - ④ - ⑤ 20. I feel like my organization is a place where I can achieve my personal goals. ① - ② - ③ - ④ - ⑤ Total: Score Assessment 86-100 Thriving - strong and consistent indicators of organizational health 61-85 Struggling – moderate or inconsistent indicators of organizational health 60 or less Suffering – low and inconsistent indicators of organizational health ORGANIZATIONAL HEALTH SELF-ASSESSMENT QUESTIONNAIRE Is your organization providing a healthy work environment?

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