* 1. Please rate the following aspects of your team (on average, as a whole):

  Excellent Good Okay Fair Poor N/A
Trust -how cohesive is your team? How much do you trust each other?
Fun/Enjoyment -how much does your team enjoy working together?
Internal Communication -how well does your team communicate/relate with each other?
External Communication -how well does your team communicate/relate with clients/customers?
Respect -how deeply do team members feel mutually respected?
Safety -how safe do team members feel to be authentic, express themeslves & resolve conflicts?
Innovation -how freely, frequently and creatively does your team innovate?
Commitment -how deeply is your team commited to your vision/mission?
Productivity -how effectively does yout ream engage in core profitable activities?
Cooperation / Collaboration -how well does your team work together?
Identity -how much does your team understand/agree with your current branding/mission?

* 2. What are the most difficult, challenging and/or frustrating dynamics within your team?

* 3. What comes to mind when you freely imagine (no limits or self-censoring judgments) the types of changes you would like to see happen in your workplace and/or with your team?

* 5. Please select any other secondary interests:

* 6. If you could imagine (again, without limits) any kind of experience(s) for your team that you think would help it become more cohesive, focused, trusting, safe, fun, respectful, innovative, communicative, cooperative, committed, etc. -what might it look like?

* 7. The following questions range from one extreme to another. Neither pole is better than the other --its merely a question of what your group is currently looking for. An answer of '3' would indicate you are looking for a balance in that dimension.

  1 2 3 4 5
Work/Play: From 1 (playful retreat) to 5 (mostly training)
Content: From 1 (few core concepts) to 5 (as much info as possible)
Interactivity: From 1 (pure top-down delivery) to 5 (highly interactive)
Length: From 1 (afternoon onsite) to 5 (two day offsite)
Risk Level: From 1 (predictable) to 5 (experimental)

* 8. Approximately how many people are you planning for?

* 9. If you know, what date range are you looking for?


* 10. Some Final Contact Details

* 11. Any final comments or questions?