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					         BEYOND SUCCESS COACHING



         Life Management Survey
                        Please enter your name on the next line


   Please take the time to read through this questionnaire and complete each
           section (marked by a separate tab in the Excel document).
   Please put a Number 1 in the box which is the most appropriate for you
                                 most of the time.

           This is a comprehensive survey - it can take you up to one week to complete.
When you have completed the survey, you should have answered questions in the following categories:
             (Please click on the module name and it will automatically take you to it)
                                        Life Management
                                             Finances
                                         Communication
                                          Assertiveness
                                            Self-Image
                                     Personal Development
                                            Leadership
                                         Self-Motivation
                                       Health and Fitness
                                             Emotions
                                     Personal Relationships
                                     Business Relationships
                                             Summary

               Now you have finished, please save the file to your
                      desktop and email it back to me at
                                  camilla@prosperitypoint.com.au
                                              Life Management
                                                              Strongly   Disagree   Not sure
                                                              Disagree
1.    I am always late.
2.    I don’t have enough time for everything.
3.    I have a series of unfinished projects.
4.    I rarely complete tasks I set myself.
5.    I am rarely early.
6.    I have more things to do than time to do them.
7.     I deliver products and services just in time.
8.     I am always in a rush.
9.     I never use a ‘to do’ list, even when things get
hectic.
10. I never have a weekly meeting with myself for the
purpose of scheduling my time.
11. I often have to cancel or reschedule
appointments because I am late.
12. The month passes quicker than I expected,
leaving me with partially finished projects.
13. I often say that I’ll have more time once I get
through the current rush.
14. I often blame others for intruding into my time.
15. I often get half way through the day and haven’t
yet started on my list of tasks.
16. Interruptions are a major problem in my life.
17. Lack of time interferes with my
fitness/meditation/diet plan.
18. I feel anxious when I am out of touch with my
office for more than a few days.
19. I work best under pressure.
20. I often have to ‘handle’ a crisis.
21. I am the ‘key person’ in many of the situations in
my life.
22. I often have my mind on the next project.
23. I often add tasks to my ‘to do’ list that I know I will
postpone or delay until another time.
24. I feel guilty when I take time for myself.
25. 'I’ll be with you in 15 minutes’ turns into an hour.

26. I get frustrated when I must wait in a line or
queue.
27. I often eat on the run.
28. I get a sense of satisfaction from solving a crisis.

29. I work so that I can have enough money/time, so
that I don’t have to work.
30. I rarely complete all the tasks on my ‘to do’ list.



Raw Score last column should equal 30                                -          -              -
Return to Index (Click Here)
Agree       Strongly
             Agree




        -          -   -
                                                      Finances

                                                                                Strongly   Disagree   Not sure       Agree       Strongly
                                                                                Disagree                                          Agree
  1. I don’t have a wealth creation plan.
  2. I have done several budgets, but none of them have really worked.

  3. I run out of money before the next pay packet.
  4. I live from payday to payday.
  5. I often say, “Just when I seem to be getting on top of things,
  something else goes wrong”.
  6. I have more debt than I am comfortable with.
  7. A pay rise does not necessarily translate into better finances for me.

  8. My money doesn't last as long as I need it to.
  9. I can keep a $100 note for quite some time as long as it remains in
  one piece. Once I break it, it seems to vanish.
  10. I do not have a comprehensive investment strategy.
  11. I often daydream about how I will spend my winnings from Lotto.

  12. I regularly buy lottery tickets, scratchies etc.
  13. My financial plans are better than my financial actions.
  14. I don't regularly calculate my net worth.
  15. As far as I am concerned, “Easy come, easy go”.
  16. I am a slave to money.
  17. I make many decisions based on “whether I can afford it”.
  18. “There is never enough”.
  19. I see that the rich are getting richer, the poor are getting poorer and
  I’m working harder to stay level.
  20. I’ll get to my savings plan as soon as I get over the current
  temporary financial hurdles.
  21. The balance owing on my Credit Cards never seems to be as low
  as I’d like.
  22. I’ve made several financial plans/budgets but never really got one
  to work successfully.

  Raw Score last column should equal 22                                                -          -              -           -              -   -


Return to Index (Click Here)
                                             Communication
                                                         Strongly   Disagree   Not sure       Agree
                                                         Disagree
1. I am often misunderstood.
2. I find it difficult to get my point of view
expressed.
3. I often feel like I’m not being listened to.
4. I feel I am not articulate or persuasive.
5. I get tongue-tied.
6. I am often blunt to the point of offending
people.
7. I often don’t understand what is being
communicated to me.
8. My attention span is too short.
9. I often think of what I should have said, after
the event.
10. I find it difficult to resolve conflict.
11. I don’t think on my feet too well.
12. I often find it difficult to concentrate on what
someone is saying.
13. I get accused of not listening.
14. I jump forward when someone is talking to me
and assume where they are headed with their part
of the conversation.
15. What is clear and obvious to me is sometimes
impossible to get across.
16. Sometimes in the middle of a sentence, I forget
what I was saying.
17. I sometimes struggle to find words to describe
what I mean.
18. It is often difficult to put words to what I feel.
19. I sometimes just can’t find any words.
20. I don’t like speaking in public.
21. If I’m under pressure to voice an opinion, I find
it difficult to think.
22. I interrupt.
23. I get excited and gush a bit.
24. I can’t stand it when a conversation lags and
will fill the silence with words.
25. When others are speaking to me I’m quite often
figuring out what I’ll say back to them.
26. I sometimes get a lost feeling because I can
see both sides of an argument.
27. I feel uncertain when expressing my opinion.

  Raw Score last column should equal 27                         -          -              -           -


Return to Index (Click Here)
Strongly
 Agree




       -   -
                                               Assertiveness
                                                         Strongly   Disagree   Not sure       Agree
                                                         Disagree
1. I am comfortable standing up for myself.
2. I don't ever confuse assertion with aggression.
3. I'm not afraid to go against the opinion of the
group.
4. I don't laugh at jokes I don't understand.
5. I speak up for my beliefs regardless of the
consequences.
6. I handle criticism with ease.
7. I am able to face life’s difficulties.
8. I have the right to an opinion.
9. I t doesn’t worry me if everyone likes me and
approves of what I do and say.
10 I prefer peace but not at any price.
11. I feel it is my place to speak up at work.
12. I feel that even nice people can disagree.
13. I prefer people to do what I say without
questioning me.
14. I have choices in nearly all situations, and I am
responsible for the consequences of my choices.
15. I see conflicts provide opportunities to grow and
are not something to be avoided.
16. I will not let others decide for me how I will
behave.
17. I evaluate myself independently of how others
evaluate me.
18. I don’t worry about things I cannot control.
19. I can discipline myself.
20. I like to prove myself to be thoroughly competent,
adequate and achieving
21. It is not difficult for me to say “no”.
22. I am able to effectively set limits for myself and
others.
23. I am able to offer constructive criticism without
becoming uncomfortable
24. I don’t feel I have to defend myself.
25. When I receive a compliment, I accept it without
being embarrassed.
26. I am able to make my own decisions.
27. I find it easy to choose my own behaviour,
thoughts, feelings and attitudes.
28. I am able to act, think and feel without having to
explain or justify myself.
29. I can be less than perfect.
30. I like having to persuade people.

  Raw Score last column should equal 30                         -         -               -           -


Return to Index (Click here)
Strongly
 Agree




           -   -
                                                      Self-Image
                                                           Strongly   Disagree   Not sure       Agree       Strongly
                                                           Disagree                                          Agree
1. I am unhappy with my level of self-esteem.
2. I disappoint myself sometimes.
3. I am unable to keep appointments with myself.
4. My promises are not always delivered on time.
5. I am dissatisfied with my level of education.
6. I don't really have a good work ethic.
7. I am not able to rest without guilt.
8. I haven't healed all of my past wounds.
9. I sometimes feel emotionally unstable.
10. I don't like myself.
11. I am glad to be who I am.
12. People don't like me.
13. I am influenced by the opinions of others.
14. I have some habits that I wish I didn’t.
15. I don't deal with the dramas of life very well.
16. I struggle with change.
17. I am dissatisfied with my body's appearance
18. I am not as fit as I want to be.
19. My relationships don't work well.
20. I have a fear or two that I'd be better off without.

  Raw Score last column should equal 20                           -          -              -           -          -   -


Return to Index (Click Here)
                                       Personal Development
                                                            Strongly   Disagree   Not sure       Agree       Strongly
                                                            Disagree                                          Agree
                                                               5          4          3            2             1
1. I feel like there are many changes I need to make
to myself.
2. I don’t respond well to personal criticism.
3. I don't have a Personal Development Plan.
4. I struggle with personal changes such as stop
smoking, lose weight etc.
5. I have enough “slip back” to previous habits to
wonder if I will really ever change.
6. People see more in me than I do.
7. I would rate my self-esteem at (use 1-5, 1 being
poor, 5 being high)
8. I would rate my self-confidence level (use 1-5, 1
being poor, 5 being high)
9. I don't look forward to changing and developing
myself.
10. I am not confident that in twelve months I’ll be
much more the ideal version of myself than I am now.

11. I don't have a sense of who I am and where I am
going.
12. I often wonder what life is all about.
13. I'm don't think my life works.
14. I not really happy with my level of “contribution” to
the culture that I live in.
15. I don't regularly take time out for myself.
16. I don't have a personal mission statement.
17. I don't have a clearly articulated set of personal
values.
18. My time management skills are below par.
19. I am more reactive than pro-active.
20. My life doesn't feel well balanced.
21. My spouse would say that my emotional bank
account is overdrawn.
22. My integrity level is not as high as I'd like.
23. I am unable to see the big picture in life and often
get distracted by today’s dramas.
24. I sometimes find it difficult to work cooperatively
with others.
25. My children would say that my emotional bank
account with them is overdrawn.
26. I don't feel that my life has meaning and purpose.

27. I don't have a clearly defined set of personal
goals spread over the broad spectrum of life.
28. I feel better when I succeed and worse when I
fail.
29. I battle to get consistency in my life.
30. I am not confident that I am on track to be a
much better person in twelve months than I am now.


 Raw Score last column should equal 30                             -          -              -           -          -   -


Return to Index (Click Here)
                                                      Leadership
                                                               Strongly   Disagree   Not sure       Agree
                                                               Disagree
1. I like to be in charge.
2. I’m a good people manager.
3. I like the challenge of taking the responsibility to lead
a group.
4. I’m a good leader because I know what I want.
5. I am a good communicator.
6. I can read people well and understand their needs.
7. People respond well to my leadership.
8. People in my teams feel respected and appreciated.
9. People in my teams feel they can contribute with out
fear of criticism.
10. I delegate well, including developing responsibility
appropriate to the task.
11. I give people in my teams the freedom to carry out
their responsibilities the way they see fit.
12. I am good at creating a warm, caring and
supportive environment for my teams.
13. My teams show a high level of professionalism.
14. I am accomplished at selecting and recruiting good
people.
15. I have a lot of contacts in a lot of fields.
16. I am very welcome when I return to previous
workplaces.

  Raw Score last column should equal 16                               -          -              -           -

Return to Index (Click Here)
Strongly
 Agree




       -   -
                                                   Self-Motivation
                                                               Strongly   Disagree   Not sure
                                                               Disagree
1. I find it difficult to get up and get going.
2. I rise with difficulty each morning.
3. I sometimes find my ‘to do’ list daunting.
4. I’m OK when I get going, but starting is often difficult.
5. I sometimes don’t know where to start on a project.
6. I sometimes get lost and can’t start because there
seems to be too much to do.
7. I am a highly qualified procrastinator.
8. I often start the next project before the current one is
completed.
9. I prefer to work in a team than run the show on my own.

10. I’m not keen to both set the agenda and implement it,
I’d rather be given a track to run on.
11. I’m not a good planner.
12. Planners drive me nuts because it takes so long to get
started.
13. I often don’t know what I want and procrastinate.
14. If given two hours to my self unexpectedly, I don’t
know what I’d do with it.

  Raw Score last column should equal 14                               -          -              -

Return to Index (Click Here)
Agree       Strongly
             Agree




        -          -   -
                                    Health & Fitness
                                                             Strongly   Disagree   Not sure
                                                             Disagree

1. I am not happy with my body shape.
2. I am not happy with my weight.
3. I am not as fit as I want to be.
4. I have inadequate energy levels.
5. I am not as healthy as I want to be.
6. I have some eating habits I want to change.
7. My diet is inadequate.
8. My eating patterns are disorganised.
9. I eat more rubbish than I want to.
10. I don’t get to exercise as much as I’d like to.
11. I get tired more easily than I want to.
12. I do not have an abundant supply of energy and
enthusiasm.
13. I do not sleep well.
14. I am not in control of cigarettes.
15. I am not in control of Coffee.
16. I am not in control of Tea.
17. I am not in control of Alcohol.
18. I am not in control of Marijuana.
19. I am not in control of Speed/Ecstasy.
20. I am not in control of Sugar.
21. I am not in control of Chocolate.
22. I am not in control of Painkillers (more than a couple
of Panadol/Aspirin per month)
23. I do not drink 1.5 to 2 litres of water per day.
24. I get at least one headache per fortnight.
25. My bowels do not move easily each day without the
use of laxatives, coffee etc.
26. I put off getting started on my diet and exercise
program.
27. If I can’t get to the gym 3 times a week, why bother?

28. Every time I attempt to get fit I injure myself.
29. I get the flu every winter.
30. I always seem to have some minor niggling injury or
ailment.
31. I have unpredictable mood swings.
32. I sometimes don’t know if I’m hot or cold.
33. I have tried every diet under the sun without
reaching my target weight.
34. I have difficulty putting weight on.
35. I have bad circulation.
36. My lungs don't work easily or to full capacity.

  Raw Score last column should equal 36                             -          -              -

Return to Index (Click Here)
Agree       Strongly
             Agree




        -         -    -
                                            Emotions
                                                            Strongly   Disagree   Not sure
                                                            Disagree
  1. I am emotionally unavailable.
  2. I don't understand myself completely.
  3. I struggle to remain calm and centred at all times.

  4. My emotions are a mystery to me.
  5. I am often “hijacked” by my emotions.
  6. I have difficulty controlling myself.
  7. I often lash out angrily at whatever gets in my way.
  8. I am often the target for someone else’s emotional
  outbursts.
  9. I know that I suppress more of my emotions than I
  should.
  10. I often feel lonely.
  11. I am unable to capably feel and express Joy.
  12. I am unable to capably feel and express Peace.

  13. I am unable to capably feel and express Love.
  14. I am unable to capably feel and express Anger
  15. I am unable to capably feel and express Sadness.

  16. I am unable to capably feel and express Fear.
  17. I am unable to capably feel and express Guilt.
  18. I am unable to capably feel and express Shame.

  19. I am aware of a number of old hurts that restrict
  my current behaviour.
  20. I not great at standing up for myself.

  Raw Score last column should equal 20                            -          -              -

Return to Index (Click Here)
Agree       Strongly
             Agree




        -         -    -
                               Personal Relationships

                                                           Strongly   Disagree   Not sure       Agree       Strongly
                                                           Disagree                                          Agree
1. I feel uncomfortable meeting new people.
2. I would like to be openhearted and honest in my
relationships, but often feel held back.
3. Making a relationship work well sounds like hard
work.
4. I wonder if there is something wrong with me
when my relationship hits stormy waters.
5. I don’t handle relationships well.
6. I am not good at confrontation.
7. I hate arguments.
8. I win arguments.
9. I feel misunderstood by my partner.
10. I find it difficult to accept compliments.
11. I’m not sure that I love myself as much as my
partner does.
12. I have difficulty expressing my inner feelings.
13. I am uncertain what I feel.
14. I wonder if I want too much from my partner.
15. I use the expression,” We just need to
communicate more”.
16. I feel I need more time with my partner.
17. My partner sometimes is oblivious to my feelings.

18. I am often angry with my partner.
19. I blame my partner for the situation.
20. I get irritated by my partners inability to change
their negative behaviours.
21. My current relationship has many similarities to a
previous one.
22. I like spending time with my partner but it is often
too long between ‘visits”.
23. Sex is difficult for me.
24. I am uncomfortable with the division of domestic
responsibilities between my partner and myself.

25. I am happier with a separate bank account of my
own in addition to our joint finances.
26. I feel incomplete without my partner.
27. My partner feels incomplete without me.

 Raw Score last column should equal 27                            -          -              -           -          -   -

Return to Index (Click Here)
                               Business Relationships
                                                                    Strongly   Disagree   Not sure       Agree       Strongly
                                                                    Disagree                                          Agree
1. I don't get on well with people in general.
2. My business relationships are not easy.
3. Doing business is often a struggle
4. I am slightly uncomfortable when money is being
discussed, especially if I am the subject. i.e. pay rise
discussions etc.
5. I find some people at work difficult to relate to.
6. I am a bit scared of my boss.
7. I find it difficult to be the boss.
8. I am uncomfortable with standing up for myself,
particularly when argued with.
9. I am not assertive.
10. I don’t feel equal to the opposite sex at work.
11. I often have to do work that I don’t like.
12. I refuse to do work that I don’t like.
13. If I’m given work to do that I don’t like I do it last, if at
all.
14. I have difficulty in staff reviews when I have to tell
someone that their performance is substandard.
15. If I lost my job this week, it would be a disaster.
16. I hate job interviews because I’m uncomfortable
saying that I’m good.
17. Change can make me feel uneasy if rushed or if it
looks like change for it’s own sake.
18. I don’t want to be doing this job for the rest of my life.


  Raw Score last column should equal 18                                    -          -              -           -         -    -

Return to Index (Click Here)
                                                 Summary

     I believe my strengths are:                           I believe my weaknesses to be:
1                                                     1
2                                                     2
3                                                     3
4                                                     4
5                                                     5
6                                                     6
7                                                     7
8                                                     8
9                                                     9
10                                                    10




     The major turning points in my life have been:
1


2


3


4


5




     My reasons for being coached are:
1


2


3




     Return to Index (Click Here)
                                                              0


                                                  Life Survey Results

                               Vulnerable         Moderate         Proficient         Optimal         Over Balanced


      Life Management                                                                                            100%

Business Relationships                                                                                           100%

        Assertiveness                                                                                            100%

       Communication                                                                                             100%

        Self-Motivation                                                                                          100%

           Leadership                                                                                            100%

             Finances                                                                                            100%

Personal Relationships                                                                                           100%

             Emotions                                                                                            100%

            Self-Image                                                                                           100%

    Health and Fitness                                                                                           100%

Personal Development                                                                                             100%

                          0%     10%        20%    30%       40%     50%        60%    70%      80%      90%          100%

				
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