APPENDIX G

DATA GATHERING INSTRUMENT

Gender:  Male  Female

Self Rated Performance

Evaluate your performance by circling the appropriate response.
Rating:
1. Substandard—Needs constant supervision
2. Below average—Needs improvement
3. Average—Satisfactorily meets criteria
4. Above average—Exceeds criteria
5. Exemplary—Deserving of unusual recognition
General criteria 1 2 3 4 5
Personality/demeanor
1 2 3 4 5
Flexible and easy to get along
Relationship skills
1 2 3 4 5
Cooperates and works well in teams
Communication skills
1 2 3 4 5
Listens, understands and expresses him/herself well
Attendance and promptness
1 2 3 4 5
Observes assigned work hours, is conscientious
Initiative
1 2 3 4 5
Works without close supervision, initiates action
Organization and time-awareness
1 2 3 4 5
Sets and observes own priorities for the best use of time
Self-control
1 2 3 4 5
Maintains composure and performs well under pressure

Nature of work
Occupation: __________________
Position: _____________________
Please indicate your level of agreement to following statements:

1=Strongly Disagree
2=Disagree
3=Neutral
4=Agree
5=Strongly Agree

Strongly Strongly
Disagree Neutral Agree
HIRING disagree agree
(2) (3) (4)
(1) (5)
I am evaluated on all the important parts of my job.
I get the same evaluation from everyone who
evaluates my work.
I get clear information on how well I am doing my
job.
I am aware on the obligations under the law and are
dedicated to a fair process.
I feel like my work is valued.
Certain jobs are more suitable for men and vice
versa.
Women’s service occupations and professions, such
as nursing and teaching are undervalued.

Strongly Strongly
Disagree Neutral Agree
PROMOTION disagree agree
(2) (3) (4)
(1) (5)
My manager / supervisor encourages me to see my
potential.
I believe that I have more potential than what I apply
in my current position.
I believe that I have more ability than what I apply in
my current position.
I am confident in going for promotion.
There are wide opportunities for training to meet my
needs.
There is a counselor or manager to talk to in the
organization about how to develop my career.
I have opportunities within my job to learn my
experience.
I have opportunities within my job to broaden my
experience.
The way my employer promotes employees is fair.
Men and women have equal opportunities for
promotion.
 Strongly Strongly
Disagree Neutral Agree
JOB CLASSIFICATION disagree agree
(2) (3) (4)
(1) (5)
I have experienced gender discrimination in the
workplace.
My supervisor does not consider gender in delegating
job assignment.
My gender does influence my profession.
All the important parts of my work are measured.
I know what is considered good and bad performance
on my job.
My supervisor/manager and I agree on what is
important and not so important on my job.
I do not get information about my job performance
often enough.

Strongly Strongly
Disagree Neutral Agree
BENEFITS disagree agree
(2) (3) (4)
(1) (5)
There are salary gaps among the same level in my
organization.
I have been denied a salary increase in my
organization.
I am satisfied with my current salary.
It is illegal to give different benefits to male and
female employees.
Women tend to get more low-paid work than men.
The amount of my salary is fair.
Men and women, who make the same job (who are
employed in same position) get paid equally.
Men and women have equal opportunities for wage
increase.
Men and women have equal opportunities for
compensations/ benefits
Men and women have equal opportunities for
bonuses