Date:

Name:

Email:

Phone:

Street Address

City, State & Zip

Position:

Organization:

Instructions: In our attempt to provide high impact, cost effective solutions to performance problems that are faced by teams and organizations we are asking for your help. Please take a few moments to respond to each item below.

1. What are the major "people" related problems that you face in your team/organization? (Please check each item that applies)

Poor Performace
Low Motivation
Poor Communication
Poor Problem Solving
Conflict
Poor Time Management
Poor Planning
Lack of Delegation
Lack of Training
Poor Teamwork
Poor Supervisory Skills
Poor Customer Relations
Diversity Related Problems
Unsafe Behavior
Other:

2. On a scale of 1 to 10, where 1 is "no impact" and 10 is "very significant negative impact", what impact are these "people" related problems having on:

1 2 3 4 5 6 7 8 9 10 Productivity
1 2 3 4 5 6 7 8 9 10 Turnover
1 2 3 4 5 6 7 8 9 10 Quality
1 2 3 4 5 6 7 8 9 10 Safety
1 2 3 4 5 6 7 8 9 10 Your Quality of Life

3. What percent of your time are you spending during an average week dealing with these problems?
4. If you could eliminate these problems, would it have any impact on the financial performance of your organization? yes no
   If "yes", what percentage impact do you think it would have?
5. What types of training is your organization currently doing? (please list below)
   
6. On the average, how much time do members of your team/organization spend in training annually?

40+ hours
20-40 hours
less than 20 hours
none

7. Who is responsible for making decisions about training and development programs for your team/organization?
   
8. Would you be interested in exploring cost effective solutions to your people problems? yes no

Thank you for your assistance