Workplace English Survey

	Workplace English Survey Please complete one form for each employee in your supervision who speaks English as a second language. Please check all that apply.
	Employee Name

	Employee's country of origin

	Manager/Supervisor

	Department

	Please answer each question.

	To be effective in his/her job, the employee needs to expand his/her oral vocabulary having to do with service work; e.g., mop, pail, disinfectant, cleanser, toilet, etc.	Yes No

	As part of his/her job, the employee needs to leave the supervisor notes from time to time, using vocabulary such as mop, pail, disinfect, clean, toilet, table, broken, etc., but the notes are difficult to decipher.	Yes No

	To be effective in his/her job, the employee needs to increase his/her oral vocabulary having to do with food service work: e.g., the names of fruits and vegetables, the names of pieces of cooking equipment (colander, rolling pin, whisk, oven mitt), or the names of different cooking processes (deep fry, sauté, grill).	Yes No

	The employee needs to write notes for the supervisor having to do with food service, but the notes are difficult to decipher.	Yes No

	The employee wants to socialize with English-speakers but doesn’t seem to know how to carry on small talk typical of US citizens on topics such as weather, sports, school activities, reality television programming, etc.	Yes No

	The employee shies away from customer service situations in which he/she might be asked for assistance; e.g., if a customer asks, “Do you have a key for….?” “Where is the ketchup?” “Can you give me directions to…?”	Yes No

	The ability of other employees to understand the employee when he/she speaks stands between him/her and promotion.	Yes No

	Other ways the Workplace English program could help in retaining/promoting this individual.