Remote Work Coaching Assessment Form
Help us understand your remote work experience and coaching needs.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Your Current Role/Job Title
*
How long have you been working remotely?
*
Please Select
Less than 6 months
6-12 months
1-3 years
More than 3 years
Which of the following best describes your remote work setup?
*
Home office (dedicated space)
Shared space at home
Co-working space
Other
Please rate your confidence in the following remote work skills:
*
Rows
Time management
Self-motivation
Virtual communication
Work-life balance
Tech troubleshooting
Not confident
1
2
3
4
5
Somewhat confident
6
7
8
9
10
Confident
11
12
13
14
15
Very confident
16
17
18
19
20
What are your biggest challenges with remote work? (Select all that apply)
*
Staying motivated
Managing distractions
Communication with team
Setting boundaries
Technical issues
Other
How do you prefer to receive coaching support?
*
One-on-one video sessions
Group workshops
Written resources/guides
Other
On a scale of 1 to 10, how satisfied are you with your current remote work experience?
*
Not satisfied
1
2
3
4
5
6
7
8
9
Extremely satisfied
10
1 is Not satisfied, 10 is Extremely satisfied
What are your main goals for remote work coaching?
*
Is there anything else you would like your coach to know? (Optional)
Submit Assessment
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