Self Assessment

Tailoring your package

The self assessment form is designed to make you aware of the strengths and weaknesses in your life.
By filling in the form we can evaluate your specific needs and tailor a product that suits you as an individual.

Fill out the online self assessment form below and we will contact you via phone or email to discuss the next step.

Name

Company

Contact number or Email address (required)

 

Work

True False               My work stimulates me

True False               I am proud of what I do for a living

True False               I feel appreciated in my workplace

True False               I respect the people I work with

True False               I know where my career is heading

True False               I respond to calls and emails within 48 hours

True False               I don’t let paperwork pile up

True False               I complete my work within reasonable hours

True False               I manage my time well

True False               I delegate without guilt

 

Finances

True False               I am satisfied with my income

True False               I have a budget that I use

True False               I pay my bills on time

True False               I know how much I owe and when it will be paid off

True False               I have an active long-term financial plan

True False               I am able to reward myself without feeling guilty

True False               I use my credit card wisely

True False               I have a will

True False               My wallet is uncluttered

True False               My tax affairs are up to date

 

Home environment

True False               I am happy with my home

True False               My home is generally clean and tidy

True False               I surround myself with things that I love

True False               I don’t acquire clutter

True False               I recycle at home

True False               My personal files are in order

True False               My bed supports me having a good sleep

True False               My bed is always properly made

True False               I have photos of loved ones on display

True False               I am happy with my mode of transport

 

Health & Body

True False               I am happy with my current weight

True False               I do some form of exercise at least 3 times a week

True False               I have a balanced diet including lots of fresh food

True False               I don’t smoke or drink alcohol excessively

True False               I drink at least 2 litres of water every day

True False               I am up to date with all necessary medical and dental checkups

True False               I am happy with the sleep I get

True False               I have appropriate clothes for my work and personal interests

True False               I am not concerned about my stress levels

True False               I feel generally well

 

Relationships

True False               I am happy with the level of intimacy in my life

True False               My partner and I respect each other and are equals

True False               I get along well with my work colleagues

True False               I make amends easily with people I have conflicts with

True False               I trust the significant people in my life

True False               I am on good speaking terms with my neighbours

True False               I consider myself to be a good friend

True False               I see people who are important to me regularly

True False               My friends and family know how much I care about them

True False               I am satisfied with my social life

 

Personal

True False               I like myself

True False               I have had a birthday party in the last 2 years

True False               I have a life outside of my work

True False               I have enough confidence to do what I want in life

True False               I have adequate holidays each year

True False               I don’t lie or exaggerate

True False               I am comfortable saying no when I need to

True False               People know they can count on me to do what I say I will do

True False               I can easily recall the last time I really laughed

True False               I have a form of creative expression

 

Image

True False               I feel confident in the clothes I wear

True False               I know what best suits me

True False               My wardrobe is full of clothes I wear

True False               I have clothes that are too small for me

True False               My wardrobe has a variety of different colours

True False               I have been shopping for clothes in the past six months

True False               I enjoy shopping

True False               I follow fashion

True False               I take pride in my appearance

True False               I receive complements on my appearance regularly

 

  Your questionnaire will be assessed in confidence

 

This self assessment form is based on the Results Coaching Systems © Copyright 2005