Please print and complete the following questionnaire, then snail-mail it to me for a free evaluation by e-mail.  Please fill out NEANDERTHAL QUIZ also.

Send to:

                    Al Bernstein, Ph. D.

                         200 E 22nd St.

                         Vancouver, WA 98663

NAME ________________________________________

E-MAIL ADDRESS____________________________

PHONE  (Required)___________________________

POSITION_________________________________________________

TYPE OF BUSINESS________________________________________

  The information you give will be held in strictest confidence.

0=NEVER   1 =SELDOM   2 =SOMETIMES  3 =FREQUENTLY  4=USUALLY  5= ALMOST  ALWAYS

YOUR COMPANY OR DEPARTMENT:

My company is as profitable as I’d like it to be                                                   0   1   2   3   4   5

My company is on the cutting edge in my industry                                            0   1   2   3   4   5

In my company, we regularly set and accomplish short and long term goals. 0   1   2   3   4   5

Our mission statement is relevant to what we do every day.                              0   1   2   3   4   5

We have had a major restructuring in the last six months,

or will have one soon                                                                                              0   1   2   3   4   5

YOUR EMPLOYEES:

My employees are well-trained and competent.                                                  0   1   2   3   4   5

My team readily accepts and implements new ideas that come from me.       0   1   2   3   4   5

My turnover rate is better than my competitors.                                                   0   1   2   3   4   5

Employees come to me with suggestions about how to do things better.         0   1   2   3   4   5

Morale is high.                                                                                                          0   1   2   3   4   5           

We are able to attract and keep talented people.                                                 0   1   2   3   4   5

YOUR MANAGEMENT STYLE:

I am a detail person.                                                                                                 0   1   2   3   4   5

I am a big picture person.                                                                                         0   1   2   3   4   5

I sometimes lose my temper.                                                                                   0   1   2   3   4   5

My job offers me opportunities to grow as a person.                                             0   1   2   3   4   5

I am a perfectionist.                                                                                                  0   1   2   3   4   5

My employees praise my management style.                                                       0   1   2   3   4   5

Advancement in my company is based on performance, not politics.                0   1   2   3   4   5

I do some things myself because others

don’t do them well enough to suit me.                                                                    0   1   2   3   4   5

Sometimes the feedback I get takes me completely by surprise.                       0   1   2   3   4   5

I readily accept and implement new ideas that come from my team.                  0   1   2   3   4   5

I take criticism well.                                                                                                           0   1   2   3   4   5

YOUR PERSONAL BALANCE:

I maintain a healthy balance between my personal and professional life.            0   1   2   3   4   5

I am a workaholic.                                                                                                       0   1   2   3   4   5

I get enough sleep.                                                                                                     0   1   2   3   4   5

I eat a reasonable diet.                                                                                              0   1   2   3   4   5

I get regular exercise.                                                                                                0   1   2   3   4   5

I use alcohol less than three times a week.                                                            0   1   2   3   4   5

I have enough time for my family.                                                                              0   1   2   3   4   5

I regularly practice my spiritual beliefs.                                                                    0   1   2   3   4   5

I'm happy most of the time.                                                                                       0   1   2   3   4   5