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Response Form
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Complete a "Self-Assessment"
Contact

 

GEMA™-Lead360 is now powered by:           

 

While an "Individual Assessment" can be completed here, go to "Contact" to arrange the "Multi-rater Assessment."

 

Response Form for the "Individual Assessment" is below:

Instructions:   FIRST, GET YOUR PARTICIPANT AND RESPONDENT CODE NAMES

FROM THE ADMINISTRATOR AT:

Email: gema@gemalead360.com or Phone: 206-729-5101
  • GEMA™-Lead360 is a "360 Degree" assessment instrument useful for teamwork and leadership development.
  • 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 will be rejected.  If some responses have been omitted, 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 this is a "self-assessment only" or 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 skills in 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 earnest efforts to nurture 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 nurturing 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 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
 

Please read the following brief  descriptions of some leadership behaviors:

  Cooperative: Cooperates with others as equals.
  Withdrawing: Is detached from others.
  Entitled: Expects special consideration from others.
  Connecting: 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 respond to the following paired-comparisions by selecting the word that best applies.  If both descriptions apply equally, respond with "Both apply equally".  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. Cooperating
Connecting
Both apply equally
Neither applies at all
 
4. Dominating
Entitled
Both apply equally
Neither applies at all
 
5. Contributing
Cooperating
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
Cooperating
Both apply equally
Neither applies at all
 
10. Contributing
Withdrawing
Both apply equally
Neither applies at all
 
11. Cooperating
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
Cooperating
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,'02,'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.

Synergistic Psychology Associates, P.A. (SPA, P.A.) will not be responsible or liable for the use or misuse of GEMA™ materials and scores.  All purchasers or users assume all responsibility for use or misuse of the materials and scoring.  SPA, P.A. will not be liable for any failure or delay in performance due in whole or in part to any cause beyond its reasonable control.  SPA, P.A. makes no warranties, expressed or implied, including warranties of merchantability or fitness for a particular purpose.  In no event will David L. Hanson, Ph.D. nor anyone else who has been involved in the creation or production of any of the printed works be liable for any indirect, special or consequential damages arising out of the purchase or use of the materials or services notwithstanding any other provision or agreement between customers and Synergistic Psychology Associates, P.A. or David L. Hanson, Ph.D.  The customer’s sole and exclusive remedy shall be correction or replacement of the printed works or scoring assessment.  SPA, P.A. reserves the right to aggregate non-specific person data obtained from processing of SPA, P.A. products and to utilize those data for research and / or statistical purposes.  SPA, P.A. may also disclose such data in non-specific person form to third parties with or without reimbursement or notification.  Additional information is found at: www.gemalead360.com

Registered © Copyright 1990,'91,'92,'93,'95,'98,'02,'09
David L. Hanson, Ph.D. All Rights Reserved. Synergistic Psychology Associates, P.A.

 


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