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Life Wheel Assessment

Answer all questions honestly, please. All responses will be kept confidential and will not be shared with any other party, person or company.

Name *

First Name

Last Name

Company (if applicable) *

1 Relationships / Family *

I spend at least 10 hours of focused time with my family each week

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I get together with friends at least once a week.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

There is no one in my life that I haven’t completely forgiven.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am actively engaged in learning how to be a better spouse, parent and/or friend.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I actively look for ways to support and help advance the success of my friends and family.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I take complete responsibility for all relationship conflicts when they arise.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I easily trust those I live and work with.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am 100% honest and open with all those I live and work with.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

It is easy for me to commit to others and honor those commitments.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I recognise when I need support and am continually seeking help.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

2 Business *

I plan my day out the day before.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

My goals are written, prominently displayed and regularly reviewed.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I love what I do and enjoy getting up every day to do my job.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am continually filled with feelings of accomplishment and satisfaction from my work

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am constantly improving my professional strengths and weaknesses.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

If I could, I would still do my job without pay.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am home with my family on time every day

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

My current business/job has the realistic potential of accomplishing all my financial goals for the next year.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

My current business/job has the realistic potential of accomplishing all my financial goals for the next 10 years.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

My current business/job gives me a feeling of significance as it makes a positive difference in the lives of others.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

3 Financial *

I have a completely detailed budget and unfailingly stick to it.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I have a professionally designed and diversified financial portfolio.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I save at least 10% of my income every month.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am credit card debt-free.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I have a dedicated six-month reserve account completely funded and set aside.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I feel that I am compensated completely according to my worth.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I have an updated and complete last will and testament.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I have the needed insurance and financial plan in place for my family should something happen to me.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I have a detailed retirement plan that will accommodate exactly what I need to live as I desire after retirement and for the rest of my life.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I live well below my means and never spend money imprudently.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

4 Spiritual *

I consider myself a spiritual person.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I take at least 20 minutes each day to meditate and reflect on my life.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Others who experience me would consider me a spiritual person.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I have a personal relationship with my spiritual source.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I study my spiritual beliefs daily.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I practice my spiritual beliefs daily.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I teach my spiritual beliefs daily.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I live completely in accordance to my spiritual beliefs.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I consistently use my spirituality to help resolve my problems.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I consistently use my spirituality to help others.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

5 Mental *

I read something instructional or inspirational for at least 30 minutes each week.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I listen to something instructional or inspirational for at least 30 minutes each week.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I stay completely current with my industry news.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I seek instructional information in my field every day.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I have a mentor whom I trust.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

All my friends are a positive influence in my life.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I never engage in gossip.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I review my major goals every week.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I review what I am grateful for every day.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I always say no to requests or obligations that don’t fit my core values or objectives.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

6 Life Style *

I have hobbies outside of work that I enjoy and take part in at least 3 times a week.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I attend cultural events (e.g., opera, museums, theatre) at least 1 time a month.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I vacation at least once a year with no work communications.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I spend as much time as I want with my family.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I spend as much time as I want with my friends.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am constantly seeking adventure, trying something new and creating diverse experiences.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I feel like there is enough time in the day to do what I both need and want to do.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I live life to the fullest every day.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I take time out to daydream every day.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I am completely present in every moment of every day.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

7 Physical *

I do strength training at least 3x a week.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I do cardiovascular exercise at least 3x a week.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I do stretching and/or yoga type exercise at least 3x a week.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

During a typical day, I watch no more than 1 hour of TV.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I eat breakfast (more than just coffee) every day.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I don’t eat fast food, ever.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I spend time outside for at least 30 minutes a day, every day.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I have undisturbed sleep for at least 8 hours each night.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I don’t drink more than 1 caffeinated beverage per day.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I drink at least 8 glasses of water per day.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Thank you for completing.

Jersey Initiatives

Auckland, New Zealand

+64 9 889 0720 brian@jerseyinitiatives.co.nz

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