Question 1 of 55

1. Name:

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2. Email: 

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3. What is the name of your company and what is your role there?

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4. At work, I am present with others (i.e. not distracted, pulled in multiple directions or doing other things)

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 6. At work, others are present with me (i.e. not distracted, pulled in multiple directions or doing other things)

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7. At home, others are present with me (i.e. not distracted, overwhelmed, pulled in multiple directions or doing other things)

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 8. I feel comfortable seeking support when I need it.

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9. I believe my colleagues feel comfortable seeking support when they need it.

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10. I feel comfortable pushing back when there is too much on my plate.

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11. I believe my colleagues feel comfortable pushing back when there is too much on their plate.

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12. I feel overwhelmed often.

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13. My colleagues seem overwhelmed often.

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14. Leadership seems overwhelmed often.

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15. Teammates often venture outside their job description to support other teammates.

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16. At work, people seek out my feedback, ideas and opinions as often as I'd like.

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17. It feels safe to take a risk. If I try something and fail, it won't be held against me.

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18. No one in my organization would deliberately undermine my efforts.

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19. At work, credit is given more than it is taken.

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20. At work, I feel comfortable making a call and taking ownership.

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21. I feel like I am given full control of my projects and can complete them without much need for oversight.

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22. My team struggles to meet deadlines.

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23. Leadership intentionally spends time building internal relationships and culture.

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24. At my organization, when people screw up, we own it and admit it openly.

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25. When there’s a big problem, people’s first tendency is to figure out who to blame.

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26. When we have a meeting at work, it always adds value to the team, project, etc.

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27. In virtual meetings, all cameras are on and people give 100% of their attention.

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28. In meetings, leaders and executives tend to speak most.

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29. At work, challenging assumptions and openly disagreeing is welcomed.

Question 30 of 55

30. At work, I am able to bring up tough issues and feel heard.

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31. At home, I am able to bring up tough issues and feel heard.

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32. Conflict is managed well within my organization

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 33. I feel comfortable managing conflict.

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34. I feel included in the way my organization functions.

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35. I make a significant contribution in my organization.

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36. I make a significant contribution in my personal life.

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37. I feel acknowledged and appreciated at work.

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38. I feel acknowledged and appreciated in my personal life.

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39. I have warm relationships at work.

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40. I feel a sense of purpose at work.

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41. I feel like I can be my best self at work.

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42. I feel like I can be my best self in my personal life.

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43. I see a future for myself at my organization.

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44. What are three words that describe how you feel about work and the culture there?

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45. What obstacles do you see in having difficult conversations?

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46. I don't always share my thoughts because…

Question 47 of 55

47. In life right now, what is most fueling and what is most challenging?

Question 48 of 55

48. Have you thought about leaving your organization? If so, what could they do to make you excited about staying and growing there? (Again, this is 100% confidential and strictly used to help us help you!) 

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49. What is one thing at work that everyone knows is happening, but no one is talking about or addressing? (i.e. what's the elephant in the room)

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50. When do you find yourself most empowered at work?

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51. What’s one thing you wish people understood about you?

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52. What is the difficult conversation that you most often avoid?

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53. If you could wave a magic wand and improve one thing about your corporate culture, what would it be?

Question 54 of 55

54. What's one thing you'd love to work on personally? i.e. is there a hard conversation you want to have, a dynamic or relationship you want to shift, does giving or receiving feedback feel hard, is there something that has been weighing on you lately? Please describe in as much detail as you'd like.

Question 55 of 55

55. When you think about the conversations you have each day, zoom out... each person you interact with, who else do they interact with? Zoom out even more, how many others do they interact with? Follow the ripple effects through internal teams, clients, home life, through partners (and then their work teams), families, communities... Based on these ripples, how many other people could be impacted by your conversations? Hundreds? Thousands?