ESC Personal Development and Wellbeing Assessment ESC Personal Development and Wellbeing AssessmentBeing an entrepreneur creates stress with long days, little sleep and even working while sick. This impairs cognitive functions, decision making, accuracy and increases in heart disease and other illnesses.Our primary goal with this Assessment is to help you be the most successful that you can be and that starts with discovering where you're at today.Our secondary goal is to obtain consolidated data to...better serve entrepreneurs through future programs we create; and,to provide statistical data to foundations and organizations to obtain grant funding to support additional entrepreneurs like you.This Assessment will take you on a deep dive to discovering areas where we can help support you ranging from mindset and leadership to spirituality and your health. We'll ask you questions on the 8 dimensions of wellbeing: physical, emotional, financial, spiritual, social/belonging, intellectual, occupational and environmental.As you might have guessed, this is not a short assessment but should take no more than 10 minutes to complete. Take note of questions that cause you discomfort as we'll ask about them at the end.Please note: Your answers to this assessment are completely confidential and will only been seen by the You Define Wellness administrator and PathFinder. Your answers may be tabulated and shared with 3rd parties for evaluation and development purposes without identifying information.Basic informationIn order to best serve you, please answer the following questions.Why do we ask these questions? When compiling statistical reports and analyses, the information requested provides important criteria to identify trends and will be used for tabulation purposes only. For pronouns, we want to make sure we address you in the manner you desire.Your Name Your NameClear selectionYour Email Your EmailClear selectionWhat age range do you fall in? What age range do you fall in?18-2930-3940-4950-5960-6970+Clear selectionWhat pronouns do you identify with? What pronouns do you identify with?He / Him / HisShe / Her / HersThey / Them / TheirsOther:Clear selectionWhen thinking about personal development and wellbeing services, what are your preferences as to the type and approach of coaching? When thinking about personal development and wellbeing services, what are your preferences as to the type and approach of coaching?More traditional or conventional12345New age, new thought, unconventional is fine with meClear selectionOccupational WellbeingAs an entrepreneur, what you DO is a key factor in who you ARE. What is your occupation What is your occupationClear selectionQuestions about your work environment - select all that apply Questions about your work environment - select all that applyStrongly AgreeAgreeDisagreeStrongly DisagreeI find it necessary to hold a second job while building my businessMy business leaves me fulfilledI work on a computer all dayI stand all dayMy work area is comfortable and does not create additional stressI take regular breaks during my work dayI often eat meals at my deskI frequently work more than 50 hours per weekClear selectionAdd any comments to elaborate on your answers in this section. Add any comments to elaborate on your answers in this section.Clear selectionMindset & LeadershipLet's look at your mindset Let's look at your mindsetStrongly AgreeAgreeDisagreeStrongly disagreeI generally have a positive attitude and outlook on life and businessI enjoy working at improving myself and my businessI adapt to change easilyReally smart people do not have to try very hardYou are who you are and you can't change thatI wait until I have all the answers before making a decisionI feel threatened by the success of othersI often get angry when I get criticism about my businessI have a clear 'Why' and am focused on itI know my life purposeClear selectionLet's look at your leadership beliefs Let's look at your leadership beliefsStrongly AgreeAgreeDisagreeStrongly DisagreeAs a leader, I can clearly state the goals others should be working towardsI break down big projects into manageable stepsWhen I need to provide criticism to others, I first try to understand their point of viewI consistently ask others for their input on the decision making processOthers would say I am a good communicatorI believe when you hire someone to do a job, you provide your expectations and then trust them to get the job donePeople around me frequently disappoint meI have a leadership team other than myselfClear selectionAdd any comments to elaborate on your answers in this section. Add any comments to elaborate on your answers in this section.Clear selectionMental Health and RelationshipsEmotional wellbeing is where we find harmony and balance in our lives.Which of the following life events have you dealt with in the past year? Which of the following life events have you dealt with in the past year?Death of a loved oneMarriage, separation or divorceLoss of income/jobLife threatening medical diagnosis of you or a loved oneLegal challenges for you or a loved oneNone of the aboveClear selectionHow would you rate the following? How would you rate the following?Strongly AgreeAgreeDisagreeStrongly DisagreeI have a good support network in my life (friends, family, caregivers)I have a regular spiritual practice (meditation, prayer, etc)I set aside time for myself every day (self care)I frequently feel overwhelmed by stress, anger, and negative emotionsI often feel depressedI am the primary caregiver for someone elseI spend too much time on social mediaIn the past 30 days, I have developed an abnormal loss of interest in doing daily activities & tasksI often feel lost and all aloneClear selectionWhat is your relationship status? What is your relationship status?In a committed, supportive, and healthy relationshipIn a relationship that is currently strugglingNone, and am seeking a partner/companionshipNone, and I like it that wayPrefer not to answerOther:Clear selectionDo you regularly participate in any groups, clubs, spiritual organizations or other activities to cultivate friendships? Do you regularly participate in any groups, clubs, spiritual organizations or other activities to cultivate friendships? Yes, onlineYes, in personYes, online and in personNo, and I prefer not toNo, but would like to find activitiesClear selectionAdd comments here Add comments hereClear selectionFinancial StabilityFinances are one of the top stressors and will impact every other segment of your wellbeing.Please answer the questions pertaining to Financial Wellness and elaborate in the comments section Please answer the questions pertaining to Financial Wellness and elaborate in the comments sectionYesNoNeeds ImprovementAre you current with your rent or mortgage?Do you have renters/homeowners, auto and life insurance?Do you have debt other than a home?Do you have an emergency savings fund to cover 3-6 months of expenses?Are you saving for a major financial event in the future (i.e. house, vacation, children's college)?Are you saving for retirement?Do you get anxious or stressed when you think about or discuss your financial situation?Clear selectionComment CommentClear selectionPhysical HealthPhysical wellbeing includes both the body itself, how we move it, and what we put in to it.Please answer these general questions about Physical Wellness Please answer these general questions about Physical WellnessYesNoNeeds ImprovementCan you walk up a flight of stairs without heavy breathing or pain?Are you dealing with chronic pain or any physical limitations?Have you recently noticed any sudden changes in your health including reactions to certain foods?Do you want to improve your nutrition?Are you following a specific eating plan (i.e. Keto, gluten-free, etc)?Do you eat out often and frequently fast food?Are you on any prescription medications?Do you regularly take vitamins or supplements?Clear selectionProvide your responses to the following habits that are considered HEALTHY. Provide your responses to the following habits that are considered HEALTHY.YesNoNeeds ImprovementAre you physically active on a daily basis?Do you consistently eat healthy, nutritious foods?Do you frequently feel bloated or have indigestion after eating?Do you have regular (daily) bowel movements?Do you drink water equal to half your body weight in ounces each day?Do you feel you are receiving enough restful sleep each night?Do you practice good daily oral hygiene?Clear selectionProvide your responses to the following habits that are considered UNhealthy.Remember, your answers are confidential and are critical to our ability to support you. Provide your responses to the following habits that are considered UNhealthy.Remember, your answers are confidential and are critical to our ability to support you. Never UseIn Recovery or TreatmentUse on occasionIt is starting to concern meOut of ControlAlcohol consumptionSmoking / Vaping / Dipping (tobacco / nicotine)Marijuana (smoking, edibles)Drugs (illegal, prescription without authorization)Caffeine consumptionSugar consumptionEating disorder (bulimia, anorexia, binge eating, orthorexia, etc)Other excessive habits (gambling, pornography, shopping, shoplifting, fitness, food)Clear selectionTo the best of your recollection, when was the last time you received the following care: To the best of your recollection, when was the last time you received the following care:Never5+ years ago3-5 years ago1-2 years agoWithin the last yearPhysical examination (including well woman/man exam)Eye examinationDental examination / teeth cleaningFull blood workup and evaluationCounseling / mental healthClear selectionWhich of the following alternative / complementary health care services do you receive at least 2x per year? Check all that apply. Which of the following alternative / complementary health care services do you receive at least 2x per year? Check all that apply.Chiropractic or AcupunctureMassage Therapy or other Body WorkHealth / Nutrition CoachingLife CoachingEnergy Work (á la Reiki)Other:Clear selectionAdd any comments to elaborate on your answers in this section. Add any comments to elaborate on your answers in this section.Clear selectionYour EnvironmentEnvironmental wellbeing is about having a safe place to live and thrive.Please answer the questions pertaining to Environmental Wellness and elaborate in the comments section Please answer the questions pertaining to Environmental Wellness and elaborate in the comments sectionYesNoDo not knowAre you now or have you been exposed to toxic chemicals at work, home, or hobbies? Do you use environmentally friendly cleaning products including room deodorizers?Do you live near farms using pesticides, high wires, power plants, or other industrial sites?Do you now, or have you in the past, lived in a building that suffered water damage?Has your home been tested for contaminants such as mold, asbestos, radon, lead, or illegal drug contamination? Do you drink filtered water?Is your home environment mostly calm, comforting and refreshing?Is your home / office cluttered and hard to find things?Are your neighbors loud or unfriendly?Clear selectionComments CommentsClear selectionWrap UpYou may have experienced emotions while completing some of the questions. Which question elicited the strongest emotion as a challenge you want to tackle? You may have experienced emotions while completing some of the questions. Which question elicited the strongest emotion as a challenge you want to tackle?Clear selectionTHE MAGIC WAND QUESTION...Assume you have a magic wand and could change ONE thing about your overall wellbeing. What would you change? THE MAGIC WAND QUESTION...Assume you have a magic wand and could change ONE thing about your overall wellbeing. What would you change?Clear selectionNow that you have taken the assessment, prioritize for us the areas you want to work on (this is not a ranking; you may use a category more than once). Now that you have taken the assessment, prioritize for us the areas you want to work on (this is not a ranking; you may use a category more than once).Not a priorityLow priorityMedium priorityHighest priorityPhysical health (includes fitness, nutrition, general physical health)Mental health (includes stress & anxiety)Relationships and communicationFinancial health (includes personal budgeting)Mindset / SuccessOccupational (includes leadership & team building)OtherClear selectionWhat do you hope to get out of participating in the Personal Development and Wellbeing program? Where do you hope to see improvement at the end of this program? What do you hope to get out of participating in the Personal Development and Wellbeing program? Where do you hope to see improvement at the end of this program?Clear selection
Being an entrepreneur creates stress with long days, little sleep and even working while sick. This impairs cognitive functions, decision making, accuracy and increases in heart disease and other illnesses.
Our primary goal with this Assessment is to help you be the most successful that you can be and that starts with discovering where you're at today.
This Assessment will take you on a deep dive to discovering areas where we can help support you ranging from mindset and leadership to spirituality and your health. We'll ask you questions on the 8 dimensions of wellbeing: physical, emotional, financial, spiritual, social/belonging, intellectual, occupational and environmental.
Please note: Your answers to this assessment are completely confidential and will only been seen by the You Define Wellness administrator and PathFinder. Your answers may be tabulated and shared with 3rd parties for evaluation and development purposes without identifying information.
Your Name
Your Email
What age range do you fall in?
What pronouns do you identify with?
When thinking about personal development and wellbeing services, what are your preferences as to the type and approach of coaching?
What is your occupation
Questions about your work environment - select all that apply
Add any comments to elaborate on your answers in this section.
Let's look at your mindset
Let's look at your leadership beliefs
Which of the following life events have you dealt with in the past year?
How would you rate the following?
What is your relationship status?
Do you regularly participate in any groups, clubs, spiritual organizations or other activities to cultivate friendships?
Add comments here
Please answer the questions pertaining to Financial Wellness and elaborate in the comments section
Comment
Please answer these general questions about Physical Wellness
Provide your responses to the following habits that are considered HEALTHY.
Provide your responses to the following habits that are considered UNhealthy.
Remember, your answers are confidential and are critical to our ability to support you.
To the best of your recollection, when was the last time you received the following care:
Which of the following alternative / complementary health care services do you receive at least 2x per year? Check all that apply.
Please answer the questions pertaining to Environmental Wellness and elaborate in the comments section
Comments
You may have experienced emotions while completing some of the questions. Which question elicited the strongest emotion as a challenge you want to tackle?
THE MAGIC WAND QUESTION...Assume you have a magic wand and could change ONE thing about your overall wellbeing. What would you change?
Now that you have taken the assessment, prioritize for us the areas you want to work on (this is not a ranking; you may use a category more than once).
What do you hope to get out of participating in the Personal Development and Wellbeing program? Where do you hope to see improvement at the end of this program?
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