Shift Supervisor Staff Feedback Request Form
Please provide honest and constructive feedback about your shift supervisor to help us improve management and workplace culture.
Your Full Name
*
First Name
Last Name
Your Department or Role
*
Name of Supervisor Being Reviewed
*
Shift Date(s) You Worked With This Supervisor
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How would you rate your overall satisfaction with this supervisor?
*
1
2
3
4
5
Please rate your supervisor on the following qualities:
*
Rows
Excellent
Good
Fair
Poor
Leadership
1
2
3
4
Communication
5
6
7
8
Fairness
9
10
11
12
Supportiveness
13
14
15
16
Problem-Solving
17
18
19
20
Approachability
21
22
23
24
What does your supervisor do well?
In what areas could your supervisor improve?
Have you experienced any issues or challenges with this supervisor? If yes, please describe.
Would you recommend this supervisor to continue in their role?
*
Yes
No
Not sure
Any additional comments or suggestions?
Submit Feedback
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