AKSHAY KAPUR
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Engagement, Mindfulness & Self-Awareness
This survey is part of a new type of
professional and personal development
effort and will help me better understand how you can improve your
focus at work, while reducing your stress levels, and overall feeling more in control
of your time.
Answers may be shared with your leaders, but will
in no way affect your performance
. Rather, the goal is to guide you towards feeling more fulfilled and balanced at work.
General Information
*
Indicates required field
Name
*
First
Last
Email
*
Job Title
*
Skill & Capacity
What makes you feel like you're "in the zone"?
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When was the last time you felt that way (either at work or at home)?
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What makes you feel overworked or overwhelmed?
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Is there a payoff or benefit to overcommitting to those things that make you feel overworked?
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Yes
No
Focus & Productivity
What would ideally improve your focus AND peace of mind at work?
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What is the #1 thing that distracts you at work?
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On a scale from 1 to 5, how distracting is this to your work? (1 = least distracting, 5 = most distracting)
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1
2
3
4
5
What else, in general, distracts you at work?
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Fitness & Attention
On a scale from 1 to 5, how energetic do you feel, on average, when you are working? (1 = not energetic at all, 5 = highly energetic)
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1
2
3
4
5
On a scale from 1 to 5, how energetic do you feel when you are NOT working? (1 = not energetic at all, 5 = highly energetic)
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1
2
3
4
5
Do you pace yourself by building in regular breaks from work?
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Yes
No
Do you regularly take time to step back to define or redefine what needs to be done?
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Yes
No
Do you ever feel guilty when you take breaks or leave early?
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Yes
No
In general, is there anything you feel guilty about? (please describe if you're willing)
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Do you give others your full presence and attention in meetings and conversations?
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Yes
No
If you answered "No" to the last question, what affects your level of attention?
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Work Hours
Typically, what time do you typically get to work (when do you start)?
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Typically, what time do you typically leave work (when do you finish)?
*
Scope & Performance
In the past year, have you experienced the scope of your job get a lot bigger?
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Yes
No
Not a lot, but a little
In the past year, has the performance bar become significantly higher?
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Yes
No
Not a lot, but a little
Training & Development
Which 3 topics below would you be most interested in learning more about? (Pick 3)
*
Mindfulness Training (improving attention, being more focused)
Stress Reduction (finding an "off" switch, reducing anxiety)
Productivity (increasing output, avoiding burnout)
Decision-Making (thinking clearly, choosing consciously)
Resilience (bouncing back, reacting less)
Self-Awareness (situational awareness, greater balance)
Creativity (overcoming blocks, thinking insightfully)
Leadership Training (communicating effectively, improving EQ)
How interested are you in INDIVIDUALIZED 1-ON-1 PHONE COACHING in the areas you selected above?
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Not Interested
Somewhat Interested
Very Interested
Extremely Interested
How interested are you in ONLINE GROUP WORKSHOPS for the areas you selected above?
*
Not Interested
Somewhat Interested
Very Interested
Extremely Interested
What difference would consistently showing up at your best make to the outcomes you hope for at work and at home?
*
Thank you for taking the time out of your day to complete this survey. Review your answers, and click on the "Submit" button when you're satisfied.
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You
Me
Testimonials
Course
About
Contact