First Name *

Last Name *

Department (if applicable)

Phone *

Email *

Please rank each statement on a scale of 1–4: 1 = Never 2 = Sometimes 3 = Often 4 = Always

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1. I have clear goals I am working toward in my work and life. *

2. I set aside time for identifying and reviewing my immediate, short-, and long-term priorities. *

3. My long-term priorities are connected to my everyday actions. *

4. I create time to think and reflect. *

5. I schedule time to explore ways to increase the value of my role and the roles of my staff to grow the organization. *

6. I effectively track appointments in my calendar. *

7. I start and end my calls and meetings on time. *

8. I pad my schedule with "extra" time for urgent and unforeseen interruptions. *

9. I can accurately estimate how long a task will take and apply that information when planning my schedule. *

10. I set aside time to map out my schedule each day/week. *

11. My daily/weekly list accurately reflects the time I have available to complete my tasks. *

12. I schedule time for specific task/project work on my calendar and stick to it. *

13. I make it a point to track my tasks and ideas outside of my memory. *

14. I set aside time to consolidate, review, and reconcile my to-do's and ideas. *

15. I create daily and/or weekly to-do lists. *

16. I am clear about the time and energy I have available to take on new work. *

17. I break down projects into do-able steps/tasks at the beginning of the process, and can streamline as needed. *

18. A project timeline is created when necessary at the beginning of a long-term project. *

19. I set project deadlines that I believe I can meet with minimal stress and anxiety. *

20. I feel confident about asking questions to clarify others' project needs. *

21. I share needed information and direction with project members. *

22. I can say no to interruptions from people. *

23. I can say no to distractions. *

24. I can stay focused throughout the day. *

25. It is OK to say no to others and honor my "no." *

26. It is OK to say yes to myself. *

27. I can say no to people requesting my time and assistance, when the request does not further my goals. *

28. I stick to set work hours. *

29. I question whether a task is worth my time and energy before committing it to a list. *

30. I can easily eliminate or "downgrade" tasks that are not a priority right now. *

31. When feeling overwhelmed or circumstances change, I can prioritize in-the-moment. *

32. My days are spent proactively, focused on my highest priorities. *

33. I can easily recognize real "fires" and emergencies, and prioritize accordingly. *

34. I am clear about my team's capacity to take on new projects/tasks. *

35. I am clear about the roles and responsibilities of my team at work and at home. *

36. I track tasks I have delegated and hold my team accountable without micromanaging. *

37. I give ample lead time for my team to complete tasks I delegate and to debrief. *

38. When planning my time, I account for the time it takes to delegate. *

39. I make it a priority to delegate tasks that will empower others and/or dilute my focus. *

40. I communicate clearly and promptly with my team. *

41. My schedule reflects my personal version of "life balance" and my time is spent intentionally. *

42. I consciously schedule tasks based on when my energy will be best to perform them. *

43. I make it a priority to refuel my energy during the week. *

44. When I feel stressed, I know how to calm myself and move forward in the present moment. *

45. When I get off track, I know how to get myself back on track. *

46. I believe there is enough time in each day. *

47. I follow a consistent morning and evening routine that feels good to me. *

48. I can accomplish my tasks, even when they are boring or hard. *

49. I can easily start and finish tasks before the deadline. *

50. I am always working on the most important tasks, not necessarily the easiest. *

51. I trust myself to follow through. *

52. I have, and use, an efficient file management system. *

53. I reserve space in my calendar to process emails. *

54. I have created strategies to manage communication channels (Voxer, Slack, email, text, etc.) with my team and clients. *

When it comes to time management / productivity / efficiency during your work day, what is your biggest frustration? *

What is your greatest accomplishment / area of strength? *

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