Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Name of Organization (if applicable)
Title/Role (if applicable)
What does your organization do? What is your mission statement? (if applicable)
How stressful is your work environment?
Very stressful
Average
Low stress
What are you or your team's main types and sources of stress?
What kinds of challenges are you looking to solve?
Stress management
Improve team morale
Improve creative problem solving
Reduce daytime fatigue
Reduce sick days
Improve listening skills & communication
Improve responsiveness to change
Improve eating and relationship to food
Team Readiness Survey
The team can use some work on morale (i.e. the level of motivation, initiative, inspiration, creativity, happiness, optimism, retention, etc.)
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The team can use some work on problem solving skills.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The team can use some work on communications skills.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The team is able to be highly responsive to change and the needs of its members.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The team is in great physical health.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Burnout is a big problem for the team.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The team can use some work on creativity and innovation.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
What are your main obstacles in the way of training and development?
What kind(s) of training are you interested in? (Check all that apply)
Yoga
Meditation/Mindfulness
Physical Fitness and Strength/Conditioning
Intuitive Eating and Nutrition
Performance Sleep Skills
Eastern Philosophy
Outdoor/Nature Experience
Nervous System Mastery (Focus/Flow State/Stress Management)
Mental Agility, Creativity and Imagination
How many people are there in your organization?
1-10
11-50
51-100
101-250
251-1000
1001+
What is the average age of the team?
How would you generally describe your business and working environment? (Check all that apply)
Office Centered
Remote/Mobile Work
Noisy and Hectic
Fast Moving
Steady and Routine
Highly Structured/Hierarchical
Decentralized and Agile
Sedentary
Physically Active
Regular Hours
Irregular Hours
Highly Competitive
Collegial and Friendly
What wellness programs and benefits do you currently provide to team members?
What types of performance and development training does the team currently do?
Do you currently offer any meditation/mindfulness support?
Yes
No
Have you ever offered outdoor experience for wellness, personal development and team development?
Yes
No
Do have an onsite fitness area or do you offer gym memberships?
Onsite fitness area
Gym memberships
None
If fitness amenities or other wellness programs are offered, to what extent are they used by the team?
Is there anything else you wish to share about your challenges and goals?