This document contains a pre-evaluation form for the Break Through Life Skills Programme, asking learners to rate on a scale of 1 to 5 questions about their work environment, development opportunities, relationships with coworkers and managers, and sense of purpose. The form collects the learner's contact information and asks them to rate 12 questions regarding what is expected of them, resources, recognition, care, encouragement, input, importance, commitment, trust, progress discussions, and learning opportunities from the past year. The questions are aimed at assessing the work environment and experience of the learner prior to beginning the life skills program.