Client Survey

Date ___________________

Company Name______________________________________________________________

Address ____________________________________________________________________

Phone _____________________________

Fax_______________________________

Business Description__________________________________________________________

Contact Person & Title _______________________________ No. of Employees _________

What are your three most important ongoing employee related problems?

a.	Difficulty hiring the right people	____	e.	Conflict & tension among employees	____
b.	High turnover	____	f.	Non-complience with company policies	____
c.	Poor performance	____	g.	Theft in the workplace	____
d.	Legal issues	____	h.	Other (please specify)_____________________

If you could eliminate these problems, which would you choose first?

Why was that your first choice?

a. Too costly d. Increased liability and legal risks

b. Low morale e. Other (please specify)______________________

c. Loss of productivity & profit

What have you done to fix the problem?

If you were given a solution that would fix the problem, would you use it?

___Yes ___No (If no, why not?)

Other Comments:

Thank you for your time and cooperation.

Please fax this back to our fax at: (519) 291-2426 or by email to: toddmason@cyg.net