Intervention Consultation Questionnaire

Thank you in advance for filling out this questionnaire so that our time focuses on equipping you with the mindset, skills, and confidence to respond to challenging employees with calm composure and clear messages.

Allow yourself at least 15-20 minutes to complete the questionnaire. The length of time depends on the severity of your situation.

The more detailed you are in your answers prepare us to develop a customized plan for you to intervene successfully and stop behaviors destroying your work culture.

This questionnaire is strictly confidential.

If we don't get a completed application from you at least 24 hours before your appointment, your Intervention Consultation may be canceled.

Please answer all the questions. Here we GO...

Intervention Consultation Questionnaire

Name(Required)

First Last

Company Role(Required)

Role of the employee exhibiting abrasive behavior:(Required)

Email(Required)

Phone(Required)

List 3-4 examples of your employee's problematic behaviors, i.e., yelling, unpredictable mood, inappropriate comments, etc.(Required)

What is happening in the organization as a result of the employee’s problematic behavior, i.e., loss of other valued employees, the threat of a lawsuit, or PR disaster?(Required)

How long have the behaviors been going on?(Required)

What has been tried so far to address the employee’s behavior, and what was the outcome of your efforts?(Required)

Rate on a scale of 1-10 (10 being the highest), the number to indicate the commitment of the executive leadership team to intervene and follow through with our suggestions to stop abrasive behavior and protect the health of your work culture.(Required)

Please enter a number from 1 to 10.

If changes are not made, describe what is likely to happen if the challenges you're facing continue? Click all that apply:(Required)

Loss of valued employees

Decreased productivity

Impact on your company brand

Impact on bottom line

*Other, please describe

*Other, please describe...

Thank you for completing.

Once I receive your questionnaire, you will receive a personal confirmation email from me (Bonnie).

412.877.8331

Intervention Consultation Questionnaire

Intervention Consultation Questionnaire

HOW DID MY FAMILY GET IN MY OFFICE?

SURPRISING WAYS YOUR UPBRINGING IMPACTS YOU AT WORK AND WHAT YOU CAN DO ABOUT IT!

QUICK LINKS

CONNECT WITH BONNIE

8865 Norwin Avenue
Suite 27, #167
North Huntingdon, PA 15642

(412) 877-8331

412.877.8331

Intervention Consultation Questionnaire

Intervention Consultation Questionnaire

HOW DID MY FAMILY GET IN MY OFFICE?

SURPRISING WAYS YOUR UPBRINGING IMPACTS YOU AT WORK AND WHAT YOU CAN DO ABOUT IT!

QUICK LINKS

CONNECT WITH BONNIE

8865 Norwin Avenue Suite 27, #167 North Huntingdon, PA 15642

(412) 877-8331

8865 Norwin Avenue
Suite 27, #167
North Huntingdon, PA 15642