“what fills your tank” questionnaire - memorial … · dessert: candy bar: ... “what fills...

1

Memorial Hermann Sugar Land (Recognition Preference Tool) Recognition is and should be personal. How one person likes to be recognized for their achievements may be different from others. In order to help me understand your preferences, I would like to know a few things about you. Please take a moment to complete this brief questionnaire.

Name _____________________________ Date________________

I prefer to be recognized:

Publicly Privately (one-on-one) No preference

I most appreciate recognition from (check all that apply):

Peers Managers Directors Executives Customers/Clients

I most enjoy (check your top 5):

Hand written thank you notes Food Flowers Movie Tickets Gift Cards Plaques/Certificates Lunch with my leaders Books Surprises Seminars/Workshops Training Project Opportunities Other (please specify):

My shirt size is (circle one):

XS S M L XL 2XL 3XL 4XL

My favorite things: Colors:

Snack:

Dessert:

Candy Bar:

Non-alcoholic Beverage:

Sports Team:

Restaurant:

Music:

Books:

Movies:

Hobbies:

I collect:

Specific dietary requirements (vegetarian, food allergies, etc.):_________________________

Is there anything else you would like me to know about you? _____________________________________________________________________________________________________________________________________________________________________________________________________________

“WHAT FILLS YOUR TANK” QUESTIONNAIRE

2

Why Not Me Statement?

________________________________________________________________________________________________________________________________________________________________________________________________

How do I Advance Health?

________________________________________________________________________________________________________________________________________________________________________________________________

My Ideas?

________________________________________________________________________________________________________________________________________________________________________________________________

What is my department PI project?

________________________________________________________________________________________________________________________________________________________________________________________________

My Annual goals are?

________________________________________________________________________________________________________________________________________________________________________________________________

How do I use PDCA?

________________________________________________________________________________________________________________________________________________________________________________________________