Response Form

Leadership Definitions

Utilizing GEMA™-Lead360

Organizational Transformation Process

Example of Score Representations

Response Form

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Response Form for Participants and Respondents

Instructions

GEMA™-Lead360 is a "360 Degree" assessment instrument useful for teamwork, leadership development and the evaluation of "Internal coaching" processes.
This form is designed to assess and evaluate a participant's work behavior.
If this is a Self-assessment, you must answer all the items and be as honest with yourself as you can.
If you are a Respondent, you must answer all the items and be as accurate as possible, given your experience with the participant. Your honest assessment of the participant will be the most helpful for individualized coaching and development. Your responses should evaluate behavioral patterns noted in recent months.
Incomplete response forms cannot be submitted. You will be asked to use your browser's "Back" button to return to the form, find your missing responses and re-submit.

Participant Code Name:

Respondent Code Name:

Cautionary Note To Respondents:
Your responses will be averaged with others in a group, unless you have been designated as a "group" of one, such as a "Boss." Only GEMA™-Lead360 scoring professionals will have access to code names. If you have any questions or doubts about the confidential status of your responses, please make sure you clarify this issue with your administrator before responding.

You must respond to all items.

Section 1: Please make use of the entire five-point scale in responding

1. Invests self in promoting meaningful work.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

2. Avoids expression of thoughts and ideas.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

3. Tells the truth.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

4. Controls for the purpose of demonstrating power over others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

5. Tries to intimidate others with excessive self-importance.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

6. Speaks well of others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

7. Actually helps others do better.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

8. Becomes more tense when pressures increase.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

9. Seeks out ways to affirm others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

10. Actually creates useful contributions.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

11. Maneuvers others by expressing self-serving needs.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

12. Works toward helping others do better.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

13. Responds constructively toward ordinary work activities.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

14. Remains relatively "happy as ever" when serious difficulties arise.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

15. Puts self-centered interests ahead of useful effort.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

16: Is hesitant to express thoughts and ideas.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

17: Makes efforts to encourage others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

18: Avoids using energy for ordinary work activities.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

19: Masterfully leads the organization into the future.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

20: Works on own individual growth.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

21: Acts as if "all knowing" or "all powerful."

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

22: Leads others in creating mutual work benefit.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

23: Appears to resist cooperating with others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

24: Tries to be a ruler over all others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

25: Promotes the attitude for treating others as equals.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

26: Is stubborn and inflexible.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

27: Assertively expresses thoughts and ideas.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

28: Participates in making useful contributions.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

29: Would rather be successful than fail.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

30: Dictates with a superior attitude.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

31: Is affirming of others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

32: Acts as if cannot relate to others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

33: Is respectfully persuasive.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

34: Would rather fail than succeed.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

35: Is moody and crabby.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

36: Initiates constructive responses toward ordinary work activities.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

37: Intentionally works against others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

38: Effectively guides others toward mutual work benefit.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

39: Appears to have little energy for ordinary work activities.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

40: Creates activity that promotes meaningful work.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

41: Gets even; is quick to retaliate.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

42: Expresses positive energy toward ordinary work activities.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

43: Seems indifferent to ordinary work activities.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

44: Makes a special effort to invest work time beyond own self-interest.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

45: Seeks out ways to affirm others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

46: Has a positive attitude toward ordinary work activities.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

47: Expects favors from others but does not return favors.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

48: Tends to express thoughts and ideas.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

49: Appears to understand the importance of encouraging others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

50: Seems insensitive to others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

51: Brags about own achievements as being superior to others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

52: Initiates friendly interactions with others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

53: Is a positive example for treating others as equals.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

54: Strives to respectfully persuade others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

55: Avoids interacting with others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

56: Appears to resist cooperating with others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

57: Makes efforts to respond to others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

58: Expects special treatment from others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

59: Masterfully creates organizational visions.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

60: Has thoughts and feelings.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

61. Avoids ordinary work activities.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

62. Initiates efforts in response to others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

63. Manipulates others for own self-serving advantage.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

64. Is involved with others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

65. Is disconnected from others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

66. Tries to control others with the use of criticism.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

67. Creates special privileges for self at the expense of others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

68. Will invest in work effort beyond own self-interest.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

69. Tends to be critical of others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

70. Is arrogant toward others.

	Never, Almost Never
	Seldom
	Sometimes
	Often
	Always, Almost Always

71. Have you responded honestly and accurately?

	Yes
	Mostly Yes
	Mostly No
	No

Only 15 more items

Please read the following brief descriptions:

	Cooperative:	Cooperates with others as equals.
	Withdrawn:	Is detached from others.
	Entitled:	Expects special consideration from others.
	Connected:	Communicates and listens with others.
	Dominating:	Attempts to control or dominate others.
	Contributing:	Leads others in positive directions.

With the participant's behavior in mind, please resond to the following paired-comparisions by selecting the word that best applies. It is best to select one of the key word descriptions as normally one word applies "the best" even if both seem to apply to some degree. In a rare instance, if both descriptions apply equally, respond with "Both apply equally". Also, one word might "just slightly" apply even if it first appears that neither applies. In a rare instance, if neither description applies at all, respond with "Neither applies at all." Only one response per item is allowed and please respond to all of the items. Mark the circle of your choice.

Which word best applies to the participant's behavior?:

1.		Withdrawing
		Connecting
		Both apply equally
		Neither applies at all

2.		Dominating
		Contributing
		Both apply equally
		Neither applies at all

3.		Cooperative
		Connecting
		Both apply equally
		Neither applies at all

4.		Dominating
		Entitled
		Both apply equally
		Neither applies at all

5.		Contributing
		Cooperative
		Both apply equally
		Neither applies at all

6.		Connecting
		Dominating
		Both apply equally
		Neither applies at all

7.		Entitled
		Withdrawing
		Both apply equally
		Neither applies at all

8.		Connecting
		Contributing
		Both apply equally
		Neither applies at all

9.		Entitled
		Cooperative
		Both apply equally
		Neither applies at all

10.		Contributing
		Withdrawing
		Both apply equally
		Neither applies at all

11.		Cooperative
		Dominating
		Both apply equally
		Neither applies at all

12.		Entitled
		Connecting
		Both apply equally
		Neither applies at all

13.		Dominating
		Withdrawing
		Both apply equally
		Neither applies at all

14.		Contributing
		Entitled
		Both apply equally
		Neither applies at all

15.		Withdrawing
		Cooperative
		Both apply equally
		Neither applies at all

Narrative comments are very helpful, but not required.

Narrative Compliments, Suggestions and Comments
Constructive compliments, suggestions and comments will be

anonymously quoted in the participant's report.

Note: Do not use the "enter" key when filling out narrative comments

as that will prematurely submit the results.

What are some especially positive and useful work characteristics of this individual?

1.
2.
3.
4.
5.

What are some developmental areas that would help this individual become more effective at work?

1.
2.
3.
4.
5.

General Comments:

Goal Evaluation and Matrix Analysis - Leadership Development (GEMA™-Lead360) and all related materials are a Registered © Copyright 1990,'91,'92,'93,'95,'98, '09 of David L. Hanson, Ph.D. with All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system, without permission in writing from the publisher.