Mental Fitness Assessment

Step 1 of 2

I am able to solve new problems quickly and effectively:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I can consistently handle multiple problems without becoming overwhelmed:*

1 -Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I am able to quickly identify changes in my ability to perform:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I experience overwhelm and/or burnout often:*

1 -Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I can manage non-human resources well. (Eg. Time, Money, Materials etc):*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I am an effective leader:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I enjoy leading people:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I can manage non-human resources well (eg. Time, Money, Materials etc):*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I am an effective leader:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I enjoy leading people:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I can initiate a task easily:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I can remained focused on a task without difficulty:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I can end or transition away from a task/project without delay or hesitation:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

My emotional state often impacts my performance:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I get derailed by challenges I did not expect:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I have a clear definition of success:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I believe my performance is a reflection of who I am:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

When facing a difficult decision, I can make up my mind quickly:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I act swiftly when urgent actions need to be taken:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I have trouble cutting my loses:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I beat myself up for mistakes I have made in the past:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I have clearly defined goals in each area of my life (Career, Financial, Social, Family, Health, Spirituality):*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I have a network of mentors and guides in whom I can confide:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I have a sense of meaning and purpose in my life:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I can quickly recognize when my performance is compromised:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I respond immediately when my performance is compromised:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

Others identify changes in my behaviour or performance before I do:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I know how to respond when my performance is compromised:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

I have habits/rituals that support my recovery when I am overwhelmed:*

1 - Strongly disagree	2 - Disagree	3 - Neutral	4 - Agree	5 - Strongly agree

The top 3 obstacles in my personal life are:*

The top 3 obstacles in my professional life are:*

List one major personal strength and one major personal weakness:*

Acknowledgements

THIS QUESTIONNAIRE IS NOT INTENDED AS PSYCHOLOGICAL OR MEDICAL SERVICE DIAGNOSTIC OF ANY KIND. THE INFORMATION CONTAINED HEREIN WILL BE USED TO INFORM SERVICE RECOMMENDATIONS ONLY AND IS NOT INTENDED TO DIAGNOSE, CURE, MITIGATE, TREAT, OR PREVENT DISEASE OR OTHER CONDITIONS AND IS NOT INTENDED TO PROVIDE A DETERMINATION OR ASSESSMENT OF YOUR STATE OF HEALTH. ALWAYS CONSULT A LICENSED HEALTHCARE PROFESSIONAL SUCH AS YOUR FAMILY PHYSICIAN OR YOUR SPECIALIST TO MAKE HEALTHCARE DECISIONS OR BEFORE STARTING ANY PROGRAM OR INTERVENTION. B. SKINNER COACHING & PSYCHOTHERAPY MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, IN CONNECTION WITH THIS TOOL, AND SHALL NOT BE HELD RESPONSIBLE OR LIABLE FOR ANY COSTS OR DAMAGES RELATED TO USE OF THIS TOOL OR ANY INFORMATION PROVIDED THEREFROM.

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I have read and agree to the acknowledgements detailed above.*

I agree

I do not agree

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