Page 1 of 3

Deptt /Sec.
EMPLOYEE MOTIVATION AND
EMPPOWERMENT ASSESSMENT FORM Page: 1 of 3

Employee Name: Employee No.

Deptt.

Period Under Review: From: To:

Sr.
No. CRITERIA DESCRIPTION YES/ NO Remarks
1.0 Employee Motivation:

1.1 Are you involved in the improvement programs related to quality

objectives?

1.2 Does your HOD/ section head appreciate your performance?

1.3 Have you been given freedom by Dept Head / Top Management to
take initiatives get oppartunity for development new skills in your job?

1.4 Suggestions given by to improve product / process / system are

accepted and implemented?

1.5 Do you have Restrictions by Management in recognition of

Innovative / new ideas?

1.6 Have you have given Innovative Ideas for Product / Process / System
Improvements?

1.7 Are you responsible for taking corrective/preventive action in your

area

1.8 Is necessary infrastructure is provided to you for carrying out your

work?

1.9 Do you feel am proud of working in this company?

1.10 Do you feel that you have better future prospects in this company?

1.11 There is a clear system of appraisal and career development in the

company?

1.12 Your seniors inform you about all the new developments going on in
the company? (Sharing of information)

1.13 Do you leave the work place after completing your work?

1.14 Are you compelled to stay in the office after office hours just because
your seniors are staying in the office?

1.15 Do you feel that you are treated fairly as compared to your
colleagues?

1.16 Even if you make some mistake your seniors encourage to learn more
about the work without creating any problem?

1.17 You can talk about your feelings and future ambitions with your
colleagues and seniors?
 Page 2 of 3

1.18 Your feelings and opinions are often asked for and listened to, no
matter what your position in the company hierarchy?

1.19 Do you feel that all in the company understands your job?

1.20 EMPOWERMENT

1.21 I use my authority in fulfilling my job / activities without any

interference.

1.22 I do not blame others. I take responsibility for my part in mistakes.

1.23 I do not keep secrets from my employees.

1.24 I do not encourage gossip or rumour.

1.25 I set high ethical standards for my behaviour towards employees and
hold myself to those standards.

2.0 I ensure that staff has the training they require.

2.1 Employees have an active role in developing objectives for

themselves, their team and the company as a whole.

2.2 I regularly check that objectives between different parts of the team or
company are congruent. Everyone pulls together for the same end
rather than competing for different results.

2.3 I have a clear system for handling employee discontent.

2.4 Employees are aware of the system for handling discontent and feel
encouraged using it to address problems.

2.5 Members of my team do not ask me simple questions. Significant

matters are brought to my attention. But smaller challenges are
considered and resolved by those responsible.

2.6 I do not build rapport with my team by sharing my weaknesses and

fears. I am honest but professional.

2.7 Employees are encouraged to make mistakes.

2.8 Employees tell me when mistakes have been made, how they have
been rectified and what the key learning’s are from such mistakes.

2.9 I have a coach or mentor who keeps me focused and motivated about
my work.

2.10 I do not teach. Instead I lead, share, encourage and stimulate team
members to grow, develop and learn.

2.11 I trust my staff.

 Page 3 of 3

3.0 AWARENESS DETAILS

3.1 Do you know the relevance and importance

of the activities being carried out by you? If
yes give details?

3.2 Do you know IMS Policy of your company?

If yes mention in next column.

3.3 Have you been trained before starting the

work? If yes write topics/subjects on which
training is given.

3.4 Do you know the consequences, which may

happen if any problem occurs due to your
work? If yes give details

3.5 Are you aware of the environmental and

safety requirements? If yes mention in next
column.

Note: You can use separate / extra papers to answer these questions, if required (only for point 3.1 to 3.5)

Signature :
Name :
Designation :
Date :

After completion return back to: Administrative Manager / Management Representative

Evaluation Method (not to be circulated):

All “YES” to be counted for positive questions and “NO” to be counted for negative questions.

Empowerment
14.17 Excellent. The person is highly empowered.

10-13 Good. The person is empowered, need to upgrade to score 14 or more?

05-09 Satisfactory, need to raise his standards. Some essential systems are missing in terms of
empowerment for employees. Commit to raise his score to 14 in the next 6 months.

0-04 Not Satisfactory, the results having lack of integrity. Take steps to improve employee empowerment
immediately. Commit to raise score to 14 in the next 6 months.

Motivation
20-25 Excellent. There is very little to zap in motivation.

14-19 Good. There are some obvious "motivation zappers" present in workplace, consider ways to reduce the
impact of these.

0.18 Motivation is probably low in the workplace. Much could be done to improve working environment.
0.19

Similarly based on the average calculation of all the employees it can be found that what is the overall status related to
motivation and empowerment.

Regarding point 3.0 If the employee has given wrong answers / details then training need has to be identified for improving
the knowledge / awareness.