Leadership by Design Survey

This survey instrument mirrors my Leadership by Design Framework for Success.  See my handout to read more about my philosophy.  The work I do supports my clients to experience these statements as true and a normal part of their daily lives.  In doing so, their personal and professional lives gain momentum and are more successful and fulfilling.


There are no right or wrong answers.  Give a rating for each statement on a scale of 1 to 5, where 5 corresponds to ‘very true’ and 1 corresponds to ‘rarely true’.  Make notes for your own clarification.


Vision. Plan. Build.

  1. I have short term and strategic visions for my life and business. ______
  2. It is easy for me to determine what information or skills I need and then go obtain it. ______
  3. It is easy for me to take in new information and apply it to my life/ business, reaping relatively immediate and tangible results. ______
  4. My life/business is moving forward and trending upward at a pace that I am pleased with. Life is moving forward how I envision it can and should. ______
  5. I feel confident that I can achieve what I want to in life/business. ______
  6. I am up to the challenges that life/business presents. ______
  7. I am current with my life and business affairs: finances, taxes, home maintenance, wills, health, income, retirement. ______
  8. My overall emotional experience of my life/business is contentment and satisfaction. ______

Empowerment.  In life.

  1. I consistently advocate for my own needs and wants; I consistently receive what I need. ______
  2. The majority of my relationships are reciprocal; there is a balance between giving and receiving. ______
  3. I have healthy boundaries in all areas of my life: personal well-being, family, parents, children, friends, work, neighbors, volunteering, career. ______
  4. I do not “dim my light” or play small. My family, friends, work get “all of me” all the time. ______
  5. I am able to say “no”, and do say “no.” ______
  6. I consistently make requests to others; and make demands as needed. ______
  7. I do NOT experience much frustration, resentment or resignation in my daily life. I do NOT hear myself making complaints as I share what is going on with friends. ______
  8. I am transparent in my conversations with others. ______
  9. I trust myself. ______

Empowerment.  In business or career.

  1. I have healthy work/life balance. ______
  2. I have energy reserves at the end of the work day and have a life outside of work. ______
  3. My voice is heard; people pay attention to what I have to say. ______
  4. I can express my thoughts. ______
  5. I can state my position and stand my ground. ______
  6. I am in action towards my business/career goals. I work my business/career consistently. ______
  7. I delegate to my team and/or gather the support I need. ______
  8. I deal with conflict in a timely and clean manner. ______
  9. I trust myself and those I work with. ______
  10. I am in my profession by choice; I have not ‘settled for’ in order to make an income. ______


Unconditionally Embrace Myself.


  1. I am proud of who I am. ______
  2. I like myself. ______
  3. I understand what I need to function day to day and give it to myself. ______
  4. I consistently make great decisions. ______
  5. I give myself the time and space I need to honor my own processes. ______
  6. I remain myself all the time: when I am in huge crowds and when I am by myself. ______
  7. If I do experience guilt or shame, it is fleeting and does not interrupt my flow of life. ______
  8. I see my strengths clearly. I can own them.  ______
  9. I do not relate to those things I am not ‘good’ at as flaws or faults. ______
  10. I value my uniqueness. I see it as my gift to others.  ______
  11. My sense of self-worth remains constant and is not dependent on specific people, opinions or events. ______


©2015 Catherine Rivers Leadership by Design | www.catherinerivers.com

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