Confidential Questionnaire

BusinessConsulting ServicesAssessment Interview #1

CONTACT INFORMATION

Company Name:
Corporate Name:
Company Address:
Primary Contact:
Office Phone:
Cell Phone:
Home Phone:
Private Email:

Preferred Contact Method: office phone cell phonehome phoneemail

NOTICE OF CONFIDENTIALITY & DISCLAIMER

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PART I About your firm

THE COMPANY

Nature of Business (i.e. healthcare, health company, education, service, retail, manufacturing, professional etc.)

______

Type of Enterprise: (corporation, small business, family business) ______

Locations: ______

Key Customer / Stakeholder Groups: ______

OPERATIONAL INFORMATION(please check appropriate boxes)

Client’s Position:

President/CEO CFO Director Other ______

Involvement/Responsibilities:

Daily OperationsAdministrativeOnlyAbsentee Other ______

Number of employees_____ full-time _____ part-time _____ Independent Contractors______

Are your employees members of a trade union?Yes No

If yes, please briefly describe your relationship with the union.

Is there a full time sales staff? Yes No

Is there a full time IT staff? Yes No

Is there a full time marketing staff? Yes No

Is there a website for the company? Yes No Address: ______

Do you have board of directors? Yes No

If yes, please briefly describe your relationship with the board.

OWNERSHIP STRUCTURE(please check appropriate boxes)

Business Ownership: Sole ProprietorC-Corp. S-Corp. PartnershipLLC

Has a valuation ever been done on the business?  Yes  No

Is a law suit pending on the business?  Yes  No

Is the company? A Franchise  Independent

Owner Name / %

Can you provide us with an organizational chart? Yes  No

What are the strengths of yourcompany? ______

What are the most significant challenges facing yourcompany?______

Briefly, please describe what prompted you to contact us:

______

PART II About your practices

Rank your view of your company’s performance from 1 to 5 (low to high) for the factors listed below. For each factor, list the words (adjectives) that you would use to describe each of the components of the company.

1.Conflict Practices

Ranking: Below Above

Poor Average Average Average Excellent

1.1Current1 2345

1.2Desired12345

1.3What words (adjectives) would you use to describe the company’scurrentconflict practices?

1.4What words (adjectives) would you use to describe your desiredconflict practices in the future?

1.5Where does conflict surface in your company?

1.5Additional Comments:

2.IndividualCommunication Skills

Ranking: Below Above

Poor Average Average Average Excellent

2.1Current1 2345

2.2Desired12345

2.3What words (adjectives) would you use to describe yourcurrent communication skills?

2.4What words (adjectives) would you use to describe your desiredcommunication practicesin the future?

2.5Additional Comments:

3. Communication PracticesWithin the Organization

Ranking: Below Above

Poor Average Average Average Excellent

3.1Current1 2345

3.2Desired12345

3.3What words (adjectives) would you use to describe the company’s current communication

practices?

3.4What words (adjectives) would you use to describe your desiredcommunication practices in the future?

3.5Additional Comments:

4.Business Change (clear mission, vision for future, path to future)

Ranking: Below Above

Poor Average Average Average Excellent

4.1Current1 2345

4.2Desired12345

4.3What words (adjectives) would you use to describe the company’scurrentpath to the future?

?

4.4What words (adjectives) would you use to describe your desiredpath to the future?

?

4.5Additional Comments:

5.Customer/Client Service(if applicable)

Ranking: Below Above

Poor Average Average Average Excellent

5.1Current1 2345

5.2Desired12345

5.3What words (adjectives) would you use to describe the company’scurrentcustomer/client

service?

5.4What words (adjectives) would you use to describe your desiredcustomer/client servicein the future?

5.4What means do you use to track your client service ability?

5.5Additional Comments:

6.Business Work Culture (teamwork, morale, commitment, innovation)

Ranking: Below Above

Poor Average Average Average Excellent

6.1Current1 2345

6.2Desired12345

6.3What words (adjectives) would you use to describe the company’scurrentbusinesswork

culture?

6.4What words (adjectives) would you use to describe your desiredbusinesswork culture in the future?

6.5Additional Comments:

7.Internal Relations(internal employees, board members)

Ranking: Below Above

Poor Average Average Average Excellent

7.1Current1 2345

7.2Desired12345

7.3What words (adjectives) would you use to describe the company’scurrentinternalstakeholder

relations?

7.4What words (adjectives) would you use to describe your desiredinternal stakeholder relations in the future?

7.5Additional Comments:

8.External Relations (customers, clients, community, natural environment)

Ranking: Below Above

Poor Average Average Average Excellent

8.1Current1 2345

8.2Desired12345

8.3What words (adjectives) would you use to describe the company’scurrentexternalstakeholder

relations?

8.4What words (adjectives) would you use to describe your desiredexternal stakeholder relations in the future?

8.5Additional Comments:

9.PersonalLeadership Practices

Ranking: Below Above

Poor Average Average Average Excellent

9.1Current1 2345

9.2Desired12345

9.3What words (adjectives) would you use to describe the company’scurrentleadershippractices?

9.4What words (adjectives) would you use to describe your desiredleadership practicesin the future?

9.5Additional Comments:

10.OrganizationalManagement Practices

Ranking: Below Above

Poor Average Average Average Excellent

10.1Current1 2345

10.2Desired12345

10.3What words (adjectives) would you use to describe the company’scurrentmanagement

practices?

10.4What words (adjectives) would you use to describe your desiredmanagement practices in the future?

10.5Additional Comments:

11.Company’s Overall Capacity to Get the Job Done

Ranking: Below Above

Poor Average Average Average Excellent

11.1Current1 2345

11.2Desired12345

11.3What words (adjectives) would you use to describe the company’soverall capacity to get the Job done?

11.4What words (adjectives) would you use to describe your desiredoverall capacity to get the Job donein the future?

11.5Additional Comments:

12.What words would you use to describe your employees?

13.What words would you use to describe this company’s financial health?

14.What words would you use to describe rate of change this company is experiencing?

And, in what direction is this change going?

15.If your company was a car, what kind car would it be?

This company is like a ______because______.

16.What are this company’sAchilles’ Heels (challenges)?

17.What is the question this company needs to discuss, that we have not or will not discuss?

18.What else would it be helpful for us to know about your company?

PART III Changes

Any significant changes taking place in yourcompany?

Merger of Existing Businesses

Acquisition of an Existing Business

Sale of an Existing Business

Purchase of an Existing Business

Expansion of an Existing Business

Other ______