Workplace Mindfulness Evaluation Form
Personal code *
Your answer
Mindfulness helps get rid of disturbing thoughts and emotions. *
I am keen on multitasking, as it allows me to accomplish a lot of tasks. *
I am unaware of the ways that I am impulsive. *
When I do something that doesn’t meet my expectations, I give myself a hard time. *
I am easily distracted. *
I have problems dealing with stressful situations. *
I find that I am uncomfortable being around people who need help. *
When someone is talking, I have trouble putting my own thoughts aside and giving them my full attention. *
When I’m concerned about something, it doesn’t occur to me that my thoughts might not be true. *
I am often preoccupied, and miss what is going on around me. *
When my thoughts overtake me and I feel worried, I don’t know how to pause or interrupt this pattern. *
I can’t imagine getting through a day without my cell phone. *
After I “send” an important e-mail or text, I often regret what I wrote. *
When I have difficult thoughts or feelings, I tend to avoid facing them for as long as I can. *
When I’m working on something, it’s difficult to differentiate between priorities and tasks that could be done later. *
I tend to have a lot of ideas that never get implemented, and I don’t know what to do about this. *
© Dr. Martha Traverso-Yepez and Andrew Safer 2016
(Post-intervention only):
Please take as much room as you need to reply to these questions.
1. What are some of the main points about “mindfulness” that resonate for you and your everyday life? *
Your answer
2. Which mindfulness practices are you finding helpful, and in what way? *
Your answer
3. How helpful has this workshop series been for you? *
Not Helpful
Extremely Helpful
Specifically, how does your study and practice of mindfulness help during the workday?
Your answer
4. Have you been able to do some meditation practice at home? *
If yes, about how many times a week?
Your answer
Usually for how long?
Your answer
5. Do you think your colleagues could benefit from learning about Workplace Mindfulness? *
Your answer
6. Do you have any suggestions on how this workshop series can be improved?
Your answer
Thank you!
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