Engagement

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Engagement, Mindfulness & Fulfillment

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 will be shared with your leaders, but will in no way affect your performance. Rather, the goal is to make sure you feel 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"? *

When was the last time you felt that way (at work or at home)? *

What maks you feel overworked or overwhelmed? *

Is there a payoff or benefit to overcommitting to those things that make you feel overworked? *

Yes No

Focus & Productivity

What would ideally improve your focus AND calm of mind at work? *

What is the #1 thing that distracts you at work? *

Rate from 1 to 5 how distracting this is to your work? (1 = least distracting, 5 = most distracting) *

What else, in general, distracts you at work? *

Fitness & Attention

Do you pace yourself by building in regular breaks from work? *

Yes No

Do you regularly take time to step back to define or redefine what needs to be done? *

Yes No

Do you ever feel guilty when you take breaks or leave early? *

Yes No

Do you give others your full presence and attention in meetings and conversations? *

Yes No

If you answered "No" to the last question, what affects your level of attention? *

Work Hours

On average, what time do you typically get to work? *

On average, what time do you typically leave work? *

Scope & Performance

In the past year, have you experienced the scope of your job get a lot bigger? *

Yes No Not a lot, but a little

In the past year, has the performance bar become significantly higher? *

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? *

Not Interested Somewhat Interested Very Interested Extremely Interested

How interested are you in ONSITE GROUP TRAINING 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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