Habits of Highly Successful People:Being Effective, Efficient and Happy Survey

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* 1. What is your age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 2. What is the highest level of education you have completed?

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* 3. What is your gender?

Female

Male

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* 4. Which best describes your position at work?

Front-line Worker and office staff

Middle Management

Executive Leader

Functional Leader

Student

Owner

Homemaker

Not Applicable

Other (please specify)

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* 5. What is your annual household income?

Under $29,999

Between $30,000 and $49,999

Between $50,000 and $99,999

Between $100,000 and $199,999

Between $200,000 and $399,999

Between $400,000 and $750,000

Over $750,000

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* 6. How satisfied are you with your current career/job?

Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very dissatisfied

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* 7. Which of the following best describes your current relationship status?

Married

Widowed

Divorced

Separated

In a domestic partnership or civil union

Single, but cohabiting with a significant other

Single, never married

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* 8. How many hours in the week do you typically work?

Under 10

Between 10 and 30

Over 30 but less than 40

Over 40 but less than 50

Over 50 but less than 60

Over 60 hours but less than 70

Over 70 hours/week

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* 9. In a typical week, how many days do you exercise?

I don't regularly exercise

Once a week

2 to 4 days a week

5 to 7 days a week

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* 10. What do you most often do for exercise?

Lift weights

Walk

Run

Hike

Swim

Dance

Aerobics

Pilates

Play a team sport

Bike

Stairmaster

Not Applicable

Other (please specify)

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* 11. How important is exercise to you?

Extremely important

Very important

Somewhat important

Not so important

Not at all important

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* 12. In a typical day, how often do you read/listen to scripture or inspiring literature?

Always

Usually

Sometimes

Rarely

Never

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* 13. How often do you meditate and practice mindfulness?

Always

Usually

Sometimes

Rarely

Never

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* 14. How often are you self-critical?

Several times per day

Daily

Weekly

Rarely

Never

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* 15. When are you aware of being self-critical and harsh toward yourself?

As it happens

Later in the day when I stop and reflect

Sometimes weeks later

I am still not aware on how critical I am about myself

Not applicable

Other (please specify)

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* 16. Are you able to forgive and let go when things go wrong?

Always

Usually

Sometimes

Rarely

Never

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* 17. In a typical week, how often do you read for personal learning and improvement?

Always

Usually

Sometimes

Rarely

Never

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* 18. Rate you level of general happiness

Far above average

Above average

Average

Below average

Far below average

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* 19. How often do you plan your day?

Always

Usually

Sometimes

Rarely

Never

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* 20. How do you plan each day?

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* 21. Do you have a life purpose?

Yes

What is your purpose?

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* 22. Do you have a written personal mission/purpose (overarching life goal) statement?

Yes

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* 23. If no, why don't you have a personal mission statement?

There is no benefit

I am too busy

I don't know how

It's too difficult

too stressful

I answered Yes to the previous question

Other (please specify)

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* 24. When you eventually retire, how do you want to be remembered?

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* 25. Do you write goals each year?

Always

Usually

Sometimes

Rarely

Never

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* 26. How often do you serve others ( either 1-1, religious or charitable organizations)?

Always

Usually

Sometimes

Rarely

Never

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* 27. In a typical day, do your meals or snacks include high carbohydrates and sugars?

Always

Usually

Sometimes

Rarely

Never

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* 28. In a typical day, how often do you snack after dinner?

Always

Usually

Sometimes

Rarely

Never

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* 29. How many hours of sleep do you get each night?

Under 5 hours

Between 5 and under 6 hours

Between 6 and 8 hours

Over 8 hours

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* 30. How often do you write in a journal?

Always

Usually

Sometimes

Rarely

Never

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* 31. How would you rank your personal productivity?

Ineffective

Average

Highly Effective

Ineffective

Average

Highly Effective

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* 32. How would you rank the health of your personal relationships at work?

Weak

Average

Very Strong

Weak

Average

Very Strong

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* 33. How would you rank the health of your personal relationships at home?

Weak

Average

Very Strong

Weak

Average

Very Strong

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* 34. What do you do to overcome discouragement?

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* 35. How often do you let discouraging events in your life stay with and let it affect your happiness?

Always

Usually

Sometimes

Rarely

Never

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* 36. How effective are you at accepting the "discouraging things" in your life and moving on with peace?

Extremely effective

Very effective

Somewhat effective

Not so effective

Not at all effective

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* 37. What do you do to overcome procrastination?

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* 38. How often do you write gratitude thoughts?

Always

Usually

Sometimes

Rarely

Never

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* 39. How often to you feel content with your life?

Always

Usually

Sometimes

Rarely

Never

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* 40. Have you ever used professional coaching or counseling to help you become more effective?

Yes

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* 41. If yes, how effective has the coaching or counseling been?

Extremely effective

Very effective

Somewhat effective

Not so effective

Not at all effective

Not Applicable (I answered no to the previous question)

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* 42. Have you received medical treatment from a doctor in order to help you be more efficient, effective and happy?

Yes

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* 43. Did the medical treatment help you to become more efficient, effective and happy?

Yes

Not applicable

Other (please specify)

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* 44. How much cash savings do you have?

A great deal

A lot

A moderate amount

A little

None at all

Other (please specify)

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* 45. How many hours per day are you on your phone (screen time)?

Less than 1 hour

Between 1 and 2 hours

Greater than 2 and less than 4 hours

More than 4 hours

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* 46. What is your level of correlation between increased screen time and feeling anxious or discouraged?

A great deal

A lot

A moderate amount

A little

None at all

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* 47. What one thing could you do to improve your personal efficiency and effectiveness?

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* 48. What one thing could you do to improve your personal happiness?

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* 49. How helpful was this survey to provide ideas for your next steps for personal improvement?

Extremely helpful

Very helpful

Somewhat helpful

Not so helpful

Not at all helpful

What can we do to improve the survey to better assist you in your improvement journey? (please specify)

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* 50. Do you want any of our coaches to help you learn from this survey and develop an action plan for improvement?

Yes, please

No, thanks

if so, contact us at rickh@ci4life.org
or go to www.ci4life.org for helpful blogs, podcasts and tools to help you on your journey for happiness!