Pre-training Assessment Pre-Training Assessment Form User Code (Sent to Your Email) * How old are you? * Birthday Gender * Are you currently SingleMarriedSeparatedWidowedDivorcedOther Height (Feets) Weight (Kg) How would you classify your overall mental health? * ExcellentGoodPoor How would you classify your eating habit? * ExcellentGoodPoor How would you classify your sleep? * ExcellentGoodPoor Symptoms Checklist (Please check all that applies to you) * Depressed mood Excessive worry Impulsivity Sleep pattern disturbance Loss of interest Decreased libido Concentration problems/forgetfulness Change in appetite Excessive guilt Decreased need for sleep Crying spells Increase risky behaviour Hallucinations Unable to enjoy activities Anxiety/ panic attacks Avoidance Increased libido Racing Thoughts Suspiciousness Excessive energy Increased irritability Excessive need for sleep Fatigue Lack of motivation None I often neglect my personal needs due to the stress of my work * 5 – Strongly agree4 – Agree3 – Neutral2 – Disagree1 – Strongly disagree My work suffers because of everything going on in my personal life. * 5 – Strongly agree4 – Agree3 – Neutral2 – Disagree1 – Strongly disagree I often need to make difficult choices between my work and my personal life. * 5 – Strongly agree4 – Agree3 – Neutral2 – Disagree1 – Strongly disagree I can recognize my emotions as I experience them. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I lose my temper when I feel frustrated. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often People have told me that I’m a good listener. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I know how to calm myself down when I feel anxious or upset. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I enjoy organizing groups. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I find it hard to focus on something over the long term. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I find it difficult to move on when I feel frustrated or unhappy. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I know my strengths and weaknesses. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I avoid conflict and negotiations. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I feel that I don’t enjoy my work. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I ask people for feedback on what I do well, and how I can improve. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I set long-term goals, and review my progress regularly. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I find it difficult to read other people’s emotions. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I struggle to build rapport with others. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often I use active listening skills when people speak to me. * 1 – Not at all2 – Rarely3 – Sometimes4 – Often5 – Very often When given a new task, I’m confident that I’ll succeed. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree When one attempt fails, I learn from it and change my approach next time. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree When a task doesn’t go to plan, it affects my self belief. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree When given a new task, I’m confident that I’ll succeed. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree I have few people at work who I can speak to about issues in the office. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree When I encounter a difficulty, I lose sight of my goal quickly. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree Sometimes I question my commitment to my job. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree I have strategies in place for dealing with stress. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree I find it easy to ask my colleagues for help. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree I feel positive about the future. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree I worry about issues that I have no control over. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree Asking for assistance reveals weakness. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree When there is fundamental change, I struggle to come around to new ways of thinking. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree I have strong goals that are clear in my mind. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree I am able to discuss my job and its challenges with people outside of work, such as family members and close friends. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree I am more likely to say “yes” than “no.” * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree Failures are hard to forget and successes are hard to remember. * 1 – Strongly disagree2 – Disagree3 – Neither agree nor disagree4 – Agree5 – Strongly agree Send me a copy of my results * Yes No If you are human, leave this field blank. 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