QUESTIONNAIRE

Please tell us your thoughts on how you are feeling about participating in a Clear Air Sports day.

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Company Name

Select one*

Please rate your emotional energy today*

RATING

I'm feeling Unmotivated

I'm feeling OK

I'm feeling Good

I'm feeling Motivated

Please rate your physical energy levels today*

RATING

I'm feeling Unmotivated

I'm feeling OK

I'm feeling Good

I'm feeling Motivated

How positively connected are you feeling with your colleagues?*

RATING

I don’t feel connected

I have some connection

Comfortable with my colleagues

Extremely connected

What do you want to get out of the day?

Do you feel participating in this program today has made a positive impact on your overall self today?*

Yes

No

Somewhat

N/A

Optional comment

Would you like to continue learning more about positive changes you can do for your health and wellbeing? If you answer yes, please provide your email address below.*

Yes

No

Optional comment

Email

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