Skip to content
Call Us Today! 440-552-6729
|
info@butlerwg.com
Search for:
Home
About Us
The BWG Difference
Services
Contact
Corporate Wellness Assessment
Well Being Assessment
virteom
2022-02-14T08:28:20-04:00
Well Being Assessment
Directions: Please rate from highly agree to highly disagree to the following questions. Choose only Two (2) categories you would like to focus on for your next coaching session.
Name
*
First
Last
Phone
*
Intellectual/Mental Wellness:
1. I feel intellectually stimulated in my social environments.
1
2
3
4
5
6
7
8
9
10
2. I have personal development goals and engage in continuing education practices.
1
2
3
4
5
6
7
8
9
10
3. I have a regular meditation practice or take brain “breaks” throughout the day.
1
2
3
4
5
6
7
8
9
10
4. I have a healthy level of control over the direction of my thoughts and judgments.
1
2
3
4
5
6
7
8
9
10
5. I am committed to personal awareness and growth.
1
2
3
4
5
6
7
8
9
10
Physical Wellness:
1. I engage in cardio exercise four or more times per week for at least 30 minutes.
1
2
3
4
5
6
7
8
9
10
2. I drink enough water and eat a healthy, balanced diet.
1
2
3
4
5
6
7
8
9
10
3. I get the needed amount of rest each night (7-9 hours for most adults).
1
2
3
4
5
6
7
8
9
10
4. I am an active participant in my personal health and have all the knowledge to succeed.
1
2
3
4
5
6
7
8
9
10
5. I have a healthy relationship with my body.
1
2
3
4
5
6
7
8
9
10
Environmental Wellness:
1. My physical environments are clean and orderly.
1
2
3
4
5
6
7
8
9
10
2. I breathe clean air and get plenty of sunlight daily.
1
2
3
4
5
6
7
8
9
10
3. I engage in environmental sustainability practices.
1
2
3
4
5
6
7
8
9
10
4. I feel pleased with the arrangements of my physical settings.
1
2
3
4
5
6
7
8
9
10
5. My environment is arranged in a way that aligns with my energy and productivity objectives.
1
2
3
4
5
6
7
8
9
10
Social Wellness:
1. I feel balanced in my role within my relationships.
1
2
3
4
5
6
7
8
9
10
2. I feel confident in my ability to nurture my relationships.
1
2
3
4
5
6
7
8
9
10
3. I feel a sense of community within my home and in other social environments.
1
2
3
4
5
6
7
8
9
10
4. I am able to resolve interpersonal conflicts.
1
2
3
4
5
6
7
8
9
10
5. I feel valued and connected in my social environments.
1
2
3
4
5
6
7
8
9
10
Occupational Wellness:
1. My work and/or hobbies are founded on meaning and purpose.
1
2
3
4
5
6
7
8
9
10
2. I have a healthy balance of work and personal life.
1
2
3
4
5
6
7
8
9
10
3. I feel it is safe to express my true self in my work relationships, and I feel secure and safe in those relationships.
1
2
3
4
5
6
7
8
9
10
4. I feel stimulated and challenged by my work and/or hobbies.
1
2
3
4
5
6
7
8
9
10
5. I have the resources and connections needed to make progress in my occupational goals.
1
2
3
4
5
6
7
8
9
10
Financial Wellness:
1. I have an understanding of wants versus needs, and I prioritize spending in a responsible way.
1
2
3
4
5
6
7
8
9
10
2. I pay my bills on time and balance my accounts regularly.
1
2
3
4
5
6
7
8
9
10
3. I have specific financial goals of paying debts and/or saving weekly/monthly.
1
2
3
4
5
6
7
8
9
10
4. I hold myself accountable for my adherence to my financial goals.
1
2
3
4
5
6
7
8
9
10
5. I have a plan for long-term financial management and retirement savings.
1
2
3
4
5
6
7
8
9
10
Emotional/Spiritual Wellness:
1. I am able to identify my emotions and determine their source.
1
2
3
4
5
6
7
8
9
10
2. I am able to healthfully process my emotions, working through them without “bottling” them.
1
2
3
4
5
6
7
8
9
10
3. I express myself honestly and calmly, and I respect and value the perspectives of others.
1
2
3
4
5
6
7
8
9
10
4. I maintain a general sense of inner peace.
1
2
3
4
5
6
7
8
9
10
5. I am rooted in ethical values and driven by the interests of the greater good.
1
2
3
4
5
6
7
8
9
10
This iframe contains the logic required to handle Ajax powered Gravity Forms.
Go to Top