The document asks respondents to rate three problems on scales of 1 to 10 for how big of a problem each is and how frequently each occurs for their organization. For each problem, respondents are prompted to circle a number to indicate where on the scales the problem falls from not much/rarely to very big/frequently.

1. How BIG of a PROBLEM are the following for you or your organization
(circle one number for each)
Write Problem 1 Here:__________________________________________________________
Not Much of a problem BIG Problem
0 1 2 3 4 5 6 7 8 9 10
Write Problem 2 Here:__________________________________________________________
Not Much of a problem BIG Problem
0 1 2 3 4 5 6 7 8 9 10
Write Problem 3 Here:__________________________________________________________
Not Much of a problem BIG Problem
0 1 2 3 4 5 6 7 8 9 10
How FREQUENT of a PROBLEM are the following for you or your organization
(circle one number for each)
Write Problem 1 Here:__________________________________________________________
Occurs Very RARELY Occurs Very FREQUENTLY
0 1 2 3 4 5 6 7 8 9 10
Write Problem 2 Here:__________________________________________________________
Occurs Very RARELY Occurs Very FREQUENTLY
0 1 2 3 4 5 6 7 8 9 10
Write Problem 3 Here:__________________________________________________________
Occurs Very RARELY Occurs Very FREQUENTLY
0 1 2 3 4 5 6 7 8 9 10