Wellness Survey This survey is totally anonymous Question Title * 1. What is the biggest disruptor in terms of getting your work done and achieving your goals? Your discipline Your health Your mindset Your general happiness Your confidence Your processes Question Title * 2. How would you describe your general health? Very poor Poor Fair Good Very good Question Title * 3. How much do you think your physical health impacts your confidence, clarity and capacity to stay calm? 1 (not at all) 2 3 4 5 (they are closely linked) Question Title * 4. How much do you think your physical health impacts you and your capacity to achieve your goals? 1 (not at all) 2 3 4 5 (they are closely linked) Question Title * 5. What is the biggest barrier to you optimising health? You’re too tired You don’t know where to start You can’t get answers to what’s wrong You have trouble sticking to any plan It’s not important to you Caving to cravings brings you undone regularly Other (please specify) Question Title * 6. How confident are you on a day-to-day basis that you can cope with all the requirements of being an entrepreneur? 1 (very dissatisfied) 2 3 4 5 (very satisfied) Question Title * 7. In the last 12 months, roughly how many days have you been absent from work due to personal illness or injury? 0-14 14-30 30-60 60+ Question Title * 8. Do you suffer from any long-term medical illnesses – eg, diabetes, arthritis, headaches or back pain? Yes No If yes, what long-term illness do you suffer from? Please state. Question Title * 9. Is this long-term condition the reason for most of your sickness absence? Yes No N/A Question Title * 10. How would you describe the following when you are at work? Very poor Poor Fair Good Very good Energy levels Energy levels Very poor Energy levels Poor Energy levels Fair Energy levels Good Energy levels Very good Mood Mood Very poor Mood Poor Mood Fair Mood Good Mood Very good Concentration Concentration Very poor Concentration Poor Concentration Fair Concentration Good Concentration Very good Stress levels Stress levels Very poor Stress levels Poor Stress levels Fair Stress levels Good Stress levels Very good Tiredness Tiredness Very poor Tiredness Poor Tiredness Fair Tiredness Good Tiredness Very good Discipline Discipline Very poor Discipline Poor Discipline Fair Discipline Good Discipline Very good Focus Focus Very poor Focus Poor Focus Fair Focus Good Focus Very good Mental clarity Mental clarity Very poor Mental clarity Poor Mental clarity Fair Mental clarity Good Mental clarity Very good Question Title * 11. Do you consider sleep an issue that negatively impacts your health, energy and clarity of thought? Yes No Question Title * 12. How likely are you to take part in each of the following programmes if they were offered to you through ICB? Stress-buster sessions Stress-buster sessions Mastering sleep to support health Mastering sleep to support health Nutrition plans to optimise health Nutrition plans to optimise health Mental health and happiness strategies Mental health and happiness strategies Creating clarity, calm and confidence Creating clarity, calm and confidence Eating to crush cravings and optimise energy Eating to crush cravings and optimise energy A weight management programme A weight management programme Happy hormones for women over 40 Happy hormones for women over 40 Self-care strategies to transform fine into Fabulous Management Movement Plans (bespoke exercise planning) Self-care strategies to transform fine into Fabulous Management Movement Plans (bespoke exercise planning) Question Title * 13. What suggestions and/or requirements in terms of your health and wellbeing do you have? Question Title * 14. For the women - are periods/menopause causing you discomfort? Yes No If yes, please specify Question Title * 15. For the women - do you have to take time away from your work on a monthly basis? Yes No If yes, how many days? Question Title * 16. For the women - are you suffering unexplained weight gain? Yes No Question Title * 17. For the gentlemen - is your waist measurement expanding inexplicably? Yes No Question Title * 18. For the gentlemen - are there health issues that are causing you concern? Yes No Question Title * 19. For the gentlemen - are your energy levels consistent? Yes No Done
