Board Self-Assessment Survey (Fidelity to the Policy Governance® Model)

Boards On Course

Board Self-Assessment of

Fidelity to

The Policy Governance® Model


Board Member's Name (optional)








1.  Our board has identified our organization's owners, that is, those people on whose behalf our board governs and to whom it is accountable. 






2.  Our board members understand that our board is accountable to the owners for the performance of our organization.






3.  Our board regularly engages in two-way communication (ownership linkage) with a representative selection of owners.






4.  Ownership linkage activities focus mostly on Ends issues.






5.  Our board only communicates its expectations of our CEO via policies or one-time directives officially approved by our board at its meetings. 






6.  Our board members demonstrate an understanding that no individual board member or committee of the board has the authority to provide direction to the CEO or to the staff.






7.  Our board has in place Ends policies that define the benefits that the board intends our organization to produce, the intended recipients of those benefits, and the worth of those benefits.






8.  Our board regularly considers ownership input in its review and revision of our Ends policies.






9.  Our board spends a significant amount of its board meeting time on Ends-related issues.






10.  Our board has in place policies that define its expectations of itself and our board's relationship to our CEO.  (These policies are called Governance Process policies and Board-Management Delegation policies or something similar.)






11.  Our board regularly evaluates its compliance with its Governance Process and Board-Management Delegation policies.






12.  Our board has in place policies that define its expectations for organizational operations.  (These policies are called Executive Limitations policies or something similar.)  These policies set boundaries on the authority granted to the CEO by prohibiting activities and situations that are unacceptable to the board.






13.  Our board has in place a broad summary policy statement for each of the four policy quadrants. (Ends, Executive Limitations, Board-Management Delegation, and Governance Process or similarly named policies)






14.  Each of our board's individual policies (policy areas below the broad summary policy statements mentioned in #13) begins with a summary statement.  Each subsequent lower level of policy provides greater detail and definition of the policy statement above it.  Our board proceeds in its policy making from broad to more clearly defined policy statements until it gets to the point where it is willing to accept any reasonable interpretation of its policy.






15.  Board members understand that the CEO has operational authority for the whole organization and is accountable to the board for the organization's performance.  In effect, the CEO is the board's only employee.






16.  Neither the full board nor any subpart of the board (individual board member, committee of the board) bypasses the CEO in providing direction to staff.






17.  Committees of the board do not engage in matters delegated to the CEO.






18.  Our board accepts the right of our CEO to any reasonable interpretation of our board's Ends and Executive Limitations policies.  Our board members do not attempt to impose on the CEO what they think might be the best or a preferred interpretation of our board's policies.






19.  Our CEO provides policy interpretations that include operational definitions, that is, measureable indicators of policy compliance and a rationale for the selection of those indicators and thresholds or targets for compliance.  Such operational definitions are provided for Ends policies and for Executive Limitations policies.






20.  Our board engages in regular ongoing monitoring of CEO/organizational compliance with Ends policies and Executive Limitations policies.






21.  In reviewing submitted monitoring reports, the board decides if the interpretations provided by the CEO are reasonable and if data have been presented that demonstrate compliance with the policies as reasonably interpreted.






22.  Our board understands that our board's ongoing monitoring of compliance with Ends policies and Executive Limitations policies constitutes the CEO's performance evaluation.  (A board may choose to develop a summative evaluation of CEO performance perhaps annually.)







Any comments related to any of the statements above? 




For a Word document of this form, please contact John Bohley by email:


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