Name: [Employee Full Name]

Department: [Department Name]

Employee ID: [ID Number]

Date of Joining: [Date of Assistance]

1. Frequency of Utilizing Open-door Policy: (Please tick the appropriate box)

• Never

• Rarely (once a year)

• Occasionally (2-3 times a year)

• Frequently (monthly or more)

2. Reasons for Accessing Open-door Policy: (Please tick all that apply)

• Addressing a workplace concern

• Providing feedback about a team or process

• Discussing personal challenges impacting work

• Seeking career advice or direction

• Others (please specify): ________________

3. Responsiveness to Your Concerns/Feedback: (Rate from 1-5, with 1 being poor and 5 being excellent)

●     Timeliness of Response: [   ]

●     Receptiveness of the listener (manager/superior): [   ]

●     Constructiveness of the feedback/solution provided: [   ]

4. Outcomes of Addressing Concerns through Open-door Policy: (Please tick if applicable)

• Concern was resolved to the satisfaction

• Referred to another department or individual for resolution

• Provided with resources or tools for self-resolution

• Concern was not addressed or remains unresolved

5. Feedback on the Open-door Policy:

Please provide a brief description of what you find beneficial about the Open-door Policy and any areas of improvement.

__________________________________________________________________________________________________________________________________

6. Do you feel confident in the confidentiality and non-retaliation aspects of the Open-door Policy?

• Yes

• No

7. Additional Comments/Suggestions:

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