Self Assessment Survey
Use the table to indicate whether you are practicing the behaviour and how frequently
you are doing so (e.g., from (1) seldom to (5) always). If you cannot practice the green
initiative, please indicate why not. If you happen to be practicing others add them to the
bottom of the table.
Green
Initiatives
Will
Practice
Already
Practicing
FREQUENCY SCALE
1=Always;
2=Almost Always;
3=Most Often;
4=Frequently;
5=Occasionally;
6=Never
Can’t
Practice
Explain
# 1 □ □ □
# 2 □ □ □
# 3 □ □ □
# 4 □ □ □
# 5 □ □ □
Other □ □ □
Please answer the questions below to provide more feedback about your experience.
Please be sure to identify and elaborate on any barriers to adopting a specific behaviour
as well any support needs you have.
1) Related to green initiatives you have already adopted, how has your experience been
so far? What support, if any, do you need to continue?
________________________________________________________________________
________________________________________________________________________
2) Related to green initiatives that you intend to adopt, when do you intend to adopt
them? What support, if any, do you need to start?
________________________________________________________________________
________________________________________________________________________
3) Related to green initiatives you cannot adopt, what are the barriers preventing you
from adopting them? What support do you need to overcome these barriers?
________________________________________________________________________
________________________________________________________________________
Self Assessment Survey
Use the table to indicate whether you are practicing the behaviour and how frequently
you are doing so (e.g., from (1) seldom to (5) always). If you cannot practice the green
initiative, please indicate why not. If you happen to be practicing others add them to the
bottom of the table.
Green
Initiatives
Will
Practice
Already
Practicing
FREQUENCY SCALE
1=Always;
2=Almost Always;
3=Most Often;
4=Frequently;
5=Occasionally;
6=Never
Can’t
Practice
Explain
# 1 □ □ □
# 2 □ □ □
# 3 □ □ □
# 4 □ □ □
# 5 □ □ □
Other □ □ □
Please answer the questions below to provide more feedback about your experience.
Please be sure to identify and elaborate on any barriers to adopting a specific behaviour
as well any support needs you have.
1) Related to green initiatives you have already adopted, how has your experience been
so far? What support, if any, do you need to continue?
________________________________________________________________________
________________________________________________________________________
2) Related to green initiatives that you intend to adopt, when do you intend to adopt
them? What support, if any, do you need to start?
________________________________________________________________________
________________________________________________________________________
3) Related to green initiatives you cannot adopt, what are the barriers preventing you
from adopting them? What support do you need to overcome these barriers?
________________________________________________________________________
________________________________________________________________________
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