Business Needs Assessment Intake Form

Contact Details

Name*

First Last

Primary Phone*

Email*

Enter Email Confirm Email

Website

Services I'm Interested in from Kyosei Coaching:*

Strategic Planning
Business Coaching
Marketing Support
Life Coaching
Speaking Engagement
Small Business Solutions Development (I.T. Consulting)
Human Resources Consulting
Team or Employee Development Training & Coaching
OTHER

(Check all that apply. If other, please specify)

... since you answered 'other,' what else can we help you with?*

How did you hear about us?*

What Blog?*

What Network Group referred you?*

What is the name of the person who referred you?*

Since you answered other, how did you find out about us?*

How long have you been in business?*

What is the nature of your business?*

Please specify how many employees you have.*

Specify how many part-time, full-time and contract.

Where do you usually work?*

Home office
Company office/worksite
Client's location
Combination of above

What key frustrations are you currently experiencing in your business?*

Survive-Level Questions

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
My business revenue covers my operating expenses.
I pay myself a regular salary that covers my personal needs.
I am on top of my finances both personally and in my business.
My personal and business debt load is manageable.
I exercise regularly, eat healthfully and get adequate sleep.
I (and those close to me) have good physical and mental health (includes being free of drug/alcohol addictions).
I (and my team) are safe from threat of physical harm and/or mental/emotional abuse at work and at home.
I have the skills and knowledge I need to ensure the survival of my business.
I am compliant / up-to-date on all required legal, licensing, insurance, permits etc. for my industry.
My relationships at home and work are healthy and supportive.
The industry my business is in is stable and growing.
I feel like I have control over whether good or bad things happen to me and my business.

Survive-Level Systems

	Yes	No	Not Sure
I have adequate insurance coverage to ensure theft, accidents, ill health and other unexpected events won't create undue hardship for me / my business.
I have a proficient bookkeeper and accountant and/or am proficient in bookkeeping/accounting myself.
I have all of the basic equipment/tools I need to run my business effectively.
I have proper contracts in place for my dealings with all clients, employees and suppliers.

Strive-Level Questions

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
I am clear on the goals and priorities of myself and my business.
I am clear on my my optimal/ideal role within the business.
I understand the industry I am in and its future directions.
I have the specific skills and knowledge I need to grow my business to the next level.
I know who my customers are and how to attract them.
I am an effective communicator (both verbally and in writing).
I engage in conflict constructively (rather than avoid it).
I am good at giving and receiving feedback.
I am able to focus and concentrate on the task at hand.
I make decisions with ease and confidence.
I engage in regular daily and weekly planning.
I plan and manage my time effectively.
I set and successfully achieve goals in my business and personal life.
My work and home environments are optimally organized.
I create and use systems to enhance quality and efficiency in my business and personal life.
I demonstrate the discipline to endure short-term discomfort to reach long- term goals.
I seldom work long hours.
I feel satisfied with my business progress and achievements so far.
I stick to a concrete plan for managing my finances/investments.
My business has grown in revenues and/or profitability every year.
I have received awards/recognition for my business accomplishments.
I have clearly defined my primary, secondary and tertiary target markets.
I have a business and/or strategic plan and refer to it regularly.
I seldom feel stressed or overwhelmed.
I am good at managing the performance of myself and my employees.

Alive-Level Questions

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
I have a written set of core values and principles that govern the actions and decisions of myself and my team.
I have effective decision-making systems in place.
I have a mentor, coach and/or mastermind group.
My daily business choices are aligned with my core values and principles.
My primary relationships are aligned with my values and principles.
My employees, customers and/or suppliers are aware of my values and principles.
I love my work/business.
I know my strengths and the areas of expertise I wish to use in my work.
I have the opportunity to use/develop these strengths and areas of expertise in my work each day.
I am clear on my ideal role in my business and spend the majority of my time in this role.
I (and any employees) am (are) clear on the core strengths, expertise and competitive advantage of our products and services.
I am confident and effective in promoting my business and enjoy doing so.
I am comfortable with mistakes and am skilled at learning from these mistakes.
I know my mission/purpose in life and my business is aligned with it.
I am clear on the core purpose/mission of my business.
I have a clear, concrete and tangible vision for my business and my life.
I feel confident in my ability to realize my vision for my business and my life.
I actively pursue continuous learning and growth both personally and professionally. (You should be able to give specific, recent examples.)
I have above average fitness and health and enjoy my health and fitness routine.
I confidently express my authentic self in life and work.
I am easily able to discern which opportunities are a fit and which are not.
My home is a calming and energizing place to be.
My workplace is a focused, productive and energizing place to be.
I maintain a healthy balance between life and work.

Thrive-Level Questions

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
I love my work as it is aligned with all of my passions.
I love my life as it is aligned with all of my passions.
My relationships both inside and outside of work are highly functional and extremely satisfying.
I am making a positive difference in the world through my business.
I am clear on the legacy I most want to leave in my life and work.
I find it effortless to stay aligned with my purpose, values, and principles.
I have customized my time and energy management strategies to optimize my performance.
I am focused, energized and in the flow in all areas of my life and work.
I am excited to get up every day.
I easily sustain an optimal level of health.
I easily make decisions that are in alignment with my values in live and work.
I focus on win/win solutions.
My passions, rather than my finances, influence my choices in life and work.
My financial standing allows me to do everything that I dream of doing.
I have a clear sense of meaning and purpose in everything I do in my life and work (even for events that are negative or beyond my control).
I can’t imagine doing anything other than what I am doing in my life and work (because this is so much who I am).
I have high confidence/trust in my ability to create the results I set out to create.
The social and environmental impact of my business is a positive one.
My business runs effectively even when I am not there.
I work in my business when I want to, not because I have to.
Succession plans are in place for all key roles in the business.

Overall Life Satisfaction Ratings

Overall Business Satisfaction Ratings

Rate your level of satisfaction with the systems and/or performance of your business in each of the following areas:

Business Systems Checklist

Daily Business Operations Systems

	Written System	Unwritten System	No System
Scripts and best practice policy for answering the telephone
1-800 phone number if some clients are non-local
Station and or Policy for receiving and opening mail
Courier # and vendor relationship setup in advance
Systems for tracking purchasing and maintaining of office supplies and equipment
Faxing and e-mailing (how-to documented, email signature, privacy policy )
Email forwarders for departmental scaling (if necessary)
Documented and tracked back up and archival strategy for hard and soft files

Marketing Systems

	Written System	Unwritten System	No System
Creating a marketing plan
Designing and producing promotional materials
Developing general leads and prospects
Creating an advertising plan
Creating a public relations plan
Creating a direct mail plan
Developing and maintaining a CRM (for leads, prospects, clients)
Developing and maintaining a website
Creating and implementing a social media strategy
Analyzing and tracking sales metrics (CRM)
Referral rewards systems.

Financial Systems

	Written System	Unwritten System	No System
Billing/invoicing customers
Receiving payments and issuing receipts
Method, policy for starting the collection process for delinquent receivables.
Purchasing policies, procedures and approvals
Payment process for supplies and inventory.
Petty cash.
Managing the accounting process with daily, weekly, monthly, quarterly, and annual reports
Managing cash with future borrowing needs secured and available
Budgeting and forecasting (understanding ratios for success)
Reporting and paying federal and provincial/state or othertaxes
Planning for federal and provincial/state or other taxes
Paying employees, contractors and payroll taxes

Human Resources Systems

	Written System	Unwritten System	No System
Recruiting new employees.
Interviewing potential employees.
Hiring procedures and policies (ie. what makes a good employee/contractor).
Employee agreements.
Employee orientation system (manuals, policies and procedures for training employees)
Payroll process, benefit plans, health and welfare trust
Other benefits documented / Performance incentive's
Performance management/development systems (performance reviews, disciplinary policies and procedures, etc.)

Are you incorporated?

Yes
No

General Corporate Systems

	Written System	Unwritten System	No System
Negotiating, drafting, and executing contracts
Developing and protecting intellectual property
Managing licensing and insurance needs and coverage
Managing and storing corporate records
Maintaining investor/shareholder relations
Planning and managing growth

Facilities Management Systems

Do you sell, develop and/or manufacture physical and/or information products?

Yes
No

Not sure?Physical products include things like T-shirts, furniture, cars - anything that has to be physically manufactured and/or shipped.

Information products include things like books, ebooks, online courses, DVD courses, etc. Basically any product that is designed to convey your information or expertise on a topic.

Physical or Information Product Development Systems

	Written System	Unwritten System	No System
Guidelines for developing product and protecting it legally
Policy for developing packaging and collateral material (e.g., catalogs, etc.)
Policy for developing/manufacturing method and process
Manufacturing costing and bidding process.

Manufacturing and Inventory Systems

	Written System	Unwritten System	No System
Selecting vendors
Determining product warranties offered
Establishing product pricing (retail and wholesale)
Establishing reorder process for inventory production
Receiving and storing product as inventory
Reconciling physical inventory with accounting records

Order Processing and Customer Service Systems

	Written System	Unwritten System	No System
Taking orders and recording the orders-by mail, fax, phone, or online
Fulfilling and packaging the orders
Sending the orders
Returns procedure for inventory receiving and customer payment return
Method, policy for responding to customer complaints (ticketing system)
Policy for replacing defective product or performing other warranty service

Do you sell/provide knowledge-based services?

Yes
No

Answer yes if your business involves charging for information and or hands-on services such as counselling, coaching, fitness training, massage, naturopathy, seminars, bookkeeping or any other professional services.

Knowledge-Based Service Development Systems

	Written System	Unwritten System	No System
Guidelines for developing service and protecting it legally
Policy for developing promotional and collateral material (e.g., catalogs, etc.)
Establishing service pricing.
Determining service guarantees.
Booking client sessions, speaking engagements, etc.
Evaluating and maintaining quality of service
Addressing complaints

What are the key challenges you would like help to address?*

List up to five.

What are the key changes you would like to see in yourself, your life and/or your work?*

List up to five.

Name

This field is for validation purposes and should be left unchanged.

	Low	Moderate	High
My Energy
My Passion for Life
My Passion for Work
My Success
My Health
My Relationships
My Confidence

	Low	Moderate	High
Marketing
Finance / Accounting
Operations
Human Resources
Strategic Planning
Administration
Business Income
Business Reputation
Owner Role In Business

	Written System	Unwritten System	No system
Maintaining and designing telephone and electrical systems
Planning permits and fees
Licensing
Facility security and emergency preplanning