Productive Day Survey Name*Company name*Address Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Position / Job Title*Office Phone NumberCell Phone NumberPrimary email address* 1. Please give a brief description of your role within the company.*2. Please rate your level of productivity today. (1 is very low, 10 is peak productivity)*123456789103. True or False? I would like to be more efficient, effective and productive in my workday.*TrueFalseAdditional comments4. True or False? I have made attempts in the past to become more organized, efficient or productive at work.*TrueFalse4a. If you responded "True" to question #5 above, please describe your past attempts and the outcomes you experienced.*5. Please choose the best description of how you're managing each of the following.*This is working wellThis is working, but there's room for improvementThis is not workingThis is a disaster!N/ATask / priority managementCalendar / time managementE-mail managementPaper / file organization and managementElectronic document organization and managementAdditional comments6. Please indicate how important is it to improve in the areas listed below.Very ImportantImportantSomewhat importantNot importantN/ATask / priority managementCalendar / time managementE-mail managementPaper / file organization and managementElectronic document organization and managementAdditional comments7. Do you use Microsoft Outlook?*YesNo8. How comfortable are you with using technology and maximizing the technology you have access to? (1 is very uncomfortable, 10 is highly comfortable)*123456789109. How interested are you in transitioning from paper to the digital management of tasks and time? This includes moving away from paper to-do lists or using a paper planner to using a digital calendar and a digital Task List such as those provided in Microsoft Outlook.*12345678910Additional comments10. When it comes to workday efficiency and productivity, what do you consider your biggest strengths?*11. When it comes to workday efficiency and productivity, what do you consider your biggest challenges?*12. Please list any possible roadblocks to achieving goals or potential resistance to change.*Additional comments13. Please rate your level of motivation to change and overcome any roadblocks, challenges or resistance—either foreseen, as listed above, or unforeseen. (1 is very low, 10 is very high)*HighMediumLow14. Your success in becoming more productive is directly proportional to your willingness to change old habits and routines and learn new skills to support new habits and routines. Please rate your level of readiness for change. (1 is very low, 10 is very high)*HighMediumLow15. What goals could you achieve if you worked more efficiently, effectively and productively? This includes doing more of something, doing something better, or doing something you're not doing at all right now. What would you expect to accomplish from operating at a higher level of efficiency and productivity? Please name at least 3 positive outcomes or benefits you expect to achieve and enjoy.*16. What would it be worth to achieve the goals you listed above? Think about all of the lost opportunities, missed deadlines, lost sales, forgotten follow-ups, stress or sleepless nights you may have experienced in previous months. What approximate annual value would you place on the outcomes and goals you could achieve when you can work more efficiently, effectively and productively?*$1,000 - $5,000/yr$5,000 - $10,000/yr$10,000 - $25,000/yr$25,000 - $50,000/yr$50,000 - $75,000/yr$75,000 - $100,000/yrGreater than $100,000/yr17. How quickly would you like to see your transformation take place?*Over a period of several months, followed by regular coaching sessionsWithin 6-8 weeks, followed by regular coaching sessionsWithin a month, followed by regular coaching sessionsOther (please specify)17a. Other*18. I promise you'll get my undivided attention, endless enthusiasm, steady support and my earnest commitment to your success in reaching your productivity goals. In return, I look forward to working with professionals who are committed to being more productive, confident in themselves and their abilities, engaged with high energy, giving of full attention and excited about the benefits greater productivity will bring in their work day and in their lives. Are you ready to step forward and step up with your commitment, attention, energy and excitement?(1 is not ready and committed, 10 is highly ready and committed)*12345678910 This iframe contains the logic required to handle AJAX powered Gravity Forms.