This survey is meant to be a self assessment on where you are on some of the best practices to develop effectiveness, efficiency and happiness habits.  After you have taken the survey the last questions are meant to help you develop a simple action plan to improve.  I hope you enjoy.   You can learn more about developing each one of these habits by going to www.ci4life.org.

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* 1. What is your age?

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

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* 3. What is your gender?

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* 4. Where do you live?

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* 5. Which best describes your position at work?

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* 6. What is your annual household income?

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

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

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

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

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

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

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* 13. How important is exercise to you?

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

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

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* 16. How often are you self-critical?

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

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

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

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* 20. Rate you level of general happiness

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* 21. How often do you plan your day?

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

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

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* 24. When you eventually retire, what do you think will be important for making you feel proud of your career?

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* 25. Do you write goals each year?

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

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

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

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

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

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* 31. How would you rank your personal productivity?

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

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

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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?

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

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* 37. What do you do to overcome procrastination?

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* 38. How often do you write gratitude thoughts?

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

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

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

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

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

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* 44. How much cash savings do you have?

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

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

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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?

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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?

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