Dear Sir/Ma’am:

Good day. We request your honest feedback for Dr Chibert Jala .

This will help as your colleague participates in a leadership enhancement program to improve
the self.
Kindly return this questionnaire with answers on or before April 9, 2019. Thank you.
Kindly rank the following statements from highest to lowest in terms of how you observe and
deal with the person (5-always; 4- most of the time; 3- sometimes, 2- rarely; 1-almost never ).
Your response will be kept confidential.
Write the corresponding number before each statement.
He/She………………………………………………………………….
_____ Treats people with respect.
_____ Cooperates in the group to achieve a goal.
_____ Listens to people’s ideas and suggestions.
_____ Invites others to be part of the decision of the team.
_____ Does what /he/she says.
_____ Makes sure that what is said or agreed upon is followed.
_____ Asks comments from people so that he/she can improve herself.
_____ Shows a clear set of principles as a person.
_____ Finds solutions to problems.
_____ Implements change to make the situation better.
_____Admits mistakes to improve the situation.
_____ Asks others for better ideas.
_____ Asks what has gone wrong so to learn from it.
_____ Spends time to pause before making decisions.
_____Identifies what is helpful for the group and what is not.
_____ Chooses what is good, right and appropriate even amidst pressure.
_____Praises people for their contribution in the group.
_____Celebrates accomplishments of people.
_____Sees to it that people are given due recognition.
_____Avoids giving gossips but instead focuses on the good works of others.
_____Communicates the goals of the organization clearly to the team.
_____Shows excitement of the future of the organization.
_____Works hard for the long term goals of the organization.
_____Influences others to work for the future of the organization.

Part 2:
1. Your message for the person:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

2. One thing that you are proud about the person:

____________________________________________________________________________
____________________________________________________________________________
3. One thing that the person needs to improve or to change:
____________________________________________________________________________
____________________________________________________________________________

Thank you very much. God bless you.