QuestionPunkQuestionPunk
無料で始める
すべてのテンプレート
Industry-Specific

Personal Self-Reflection & Growth Check-In

A periodic check-in that measures how often people reflect, how self-aware they feel, and what's actually blocking deeper reflection — paired with an AI follow-up that walks through one real moment of insight instead of vague self-ratings. Built for coaches, HR wellbeing programs, and personal-development tools tracking growth over time.

このテンプレートを使うほかのテンプレートを見る

設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全13問・約7分
Q01
メッセージ

Thanks for taking a few minutes to check in with yourself. Your responses are completely confidential and anonymized. This isn't a test — there are no right answers, just honest ones. It should take about 5 minutes.

Q02
選択式必須

In the last 30 days, how often have you deliberately set aside time to reflect on your thoughts, decisions, or behavior?

  • Never
  • Once or twice
  • About weekly
  • Almost daily
Q03
マトリクス必須

How much do you agree with each statement about yourself?

4行 × 5列
  • I understand why I react the way I do in stressful situations
  • I can spot recurring patterns in my own behavior over time
  • I revisit and update my assumptions when I get new information
  • I have a clear sense of how others actually perceive me
列: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q04
オピニオンスケール必須

How satisfied are you with your personal growth over the past 3 months?

スケール: 1 – 7
最小:Not at all satisfied最大:Extremely satisfied
Q05
ランク付け必須

Rank the areas of your life you most want to focus your reflection and growth on right now, from most to least important.

  1. Career & work
  2. Relationships
  3. Health & wellbeing
  4. Finances
  5. Personal growth & mindset
  6. Purpose or meaning
ドラッグして順位を付ける
Q06
ベスト・ワースト選択（MaxDiff）必須

From the reflection practices below, which do you find most valuable and which do you find least valuable?

  • Journaling
  • Meditation or quiet sitting
  • Talking with a mentor, coach, or therapist
  • Reviewing progress on goals
  • Walking or unstructured alone time
  • Gratitude practice
  • Asking others for honest feedback
  • Structured self-assessment tools
各セットで最も良いもの・最も悪いものを選択最も良い:Most valuable to me最も悪い:Least valuable to me
Q07
評価スケール必須

How much progress have you made toward the personal goals you set for yourself this quarter?

範囲: 1 – 5
最小:No progress at all最大:Fully achieved
Q08
選択式

What usually gets in the way of you reflecting more often?

  • Not enough time
  • It's uncomfortable to sit with
  • I don't know how to do it well
  • I don't see the value in it
  • Nothing gets in the way
Q09
自由回答（長文）

Describe one insight about yourself you've had recently — what prompted it and what, if anything, has changed since?

Q10
AIインタビュー

Have the respondent walk you through one specific, recent moment when they reflected on themselves or their behavior — not a general habit, but a single real instance. Anchor on: what triggered the reflection, what they actually realized (not just how they felt), and whether they changed any behavior afterward. If they say reflection rarely leads to real change, probe what would make an insight 'stick' for them instead of fading.

Q11
選択式

What is your age range?

  • Under 18
  • 18-24
  • 25-34
  • 35-44
  • 45-54
  • 55-64
  • 65+
  • Prefer not to say
Q12
選択式

Which best describes your current life or career stage?

  • Student
  • Early career
  • Mid career
  • Senior/leadership role
  • Between roles or career change
  • Retired
  • Prefer not to say
Q13
メッセージ

That's everything — thank you for being honest with yourself here. Your responses feed into a private growth report so you (or your coach) can track how your self-awareness and goals shift over time.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Combines structured pulse questions (opinion scale, rating, matrix, ranking, max-diff) with a guided AI follow-up interview that has the respondent walk through one specific, recent moment of reflection, surfacing a real example instead of relying only on self-rated averages.
  • Includes a dedicated open-ended prompt on a recent self-insight and a direct multiple-choice question on what blocks reflection, giving both qualitative depth and structured barrier data in the same check-in.
  • Uses conversational chat-message framing at the start and end to set a non-judgmental, low-pressure tone suited to coaching and HR wellbeing contexts, not just a generic form.
  • Captures age range and life/career stage so responses can be segmented and tracked over time for coaches, HR wellbeing programs, or personal-development tools measuring growth.

Jotform

Self Reflection Survey Form Template

A ready-to-field static form template covering self-reflection topics, built on Jotform's drag-and-drop form builder. It's easy to customize fields and branding, but it's a fixed question set with no adaptive logic beyond basic conditional branching. Best suited for teams that just need a quick, low-cost intake form rather than a deeper interview-style check-in.

優れている点

  • Simple to customize and re-brand within Jotform's form builder
  • Part of a large, established template library with broad integration options
  • Likely fast to deploy for teams already using Jotform for other forms

物足りない点

  • Static question set with no adaptive AI follow-up probing into individual answers
  • No voice AI interview option or guided screen-share tasks
  • No automated per-response quality scoring or transparent prompt methodology disclosed

SurveySparrow

Self Reflection Survey Form Template for Personal Growth

A community template built on SurveySparrow's conversational survey format, presenting self-reflection questions one at a time in a chat-like flow. This improves completion feel over a flat form, but the questions themselves remain fixed and pre-written rather than adapting to what a respondent actually says. It's a usable starting template, not an interview-style instrument.

優れている点

  • Conversational, one-question-at-a-time UI that can feel more personal than a static form
  • Framed specifically around personal growth, matching the check-in use case
  • Likely easy to share and embed via SurveySparrow's distribution tools

物足りない点

  • No adaptive AI follow-up that probes deeper into a specific answer a respondent gives
  • No voice AI interview or guided task/screen-share capability
  • No disclosed automated quality scoring or transparent prompt-level methodology

よくあるご質問

「Personal Self-Reflection & Growth Check-In」テンプレートにはどのような設問が含まれていますか？

すぐに使える設問が13問含まれており、最初の設問は次のとおりです：「Thanks for taking a few minutes to check in with yourself. Your responses are completely confidential and anonymized. Th…」・「In the last 30 days, how often have you deliberately set aside time to reflect on your thoughts, decisions, or behavior?」・「How much do you agree with each statement about yourself?」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか？

回答者は通常、13問を約7分で回答し終えます。

テンプレートは編集できますか？

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか？

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか？

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

このテンプレートを使う無料で始める

関連テンプレート

似たテーマのほかの調査もご覧ください。

すべて見る
Industry-Specific

Mid-Year Performance Review Pulse Survey

Captures how employees see their progress at the midpoint of the year — goal status, manager support, obstacles, and priorities for the second half — so managers and HR can course-correct before year-end reviews lock in. An AI follow-up interview reconstructs the real story behind each person's progress rating and top obstacle instead of just the label they picked.

テンプレートを見る
Industry-Specific

Self-Improvement Habits and Progress Check-In

Captures how people are actually pursuing personal growth — which areas they're working on, how consistently they show up, and what's really stopping them — with an AI follow-up interview that digs into the real story behind their biggest obstacle. Built for coaches, app makers, and researchers studying habit formation and motivation.

テンプレートを見る
Industry-Specific

Personal Health & Wellness Check-In Survey

A periodic self-assessment covering physical health, sleep, stress, activity levels, and emerging symptoms — used by clinics, employers, or wellness programs to spot concerns early. An AI follow-up interview digs into whatever symptom or concern the respondent flagged as most pressing, capturing duration, severity, and impact that a checkbox can't.

テンプレートを見る
Industry-Specific

Employee Performance Review & Development Check-In

A structured self-assessment for performance review cycles, covering goal progress, core competencies, manager support, and development priorities — paired with an AI follow-up interview that digs into the story behind the ratings, not just the numbers, for richer 1:1 prep and calibration.

テンプレートを見る
Industry-Specific

Monthly Employee Happiness Check-In

A recurring pulse that tracks overall happiness and satisfaction across work, relationships, health, and growth month over month, with an AI follow-up that digs into whichever area is driving the score up or down. Built for HR and people teams running a lightweight monthly wellbeing cadence. Takes about 4 minutes.

テンプレートを見る
Industry-Specific

Employee Self-Evaluation & Performance Reflection Survey

A structured self-evaluation for performance review cycles, covering goal achievement, competency ratings, challenges, and development priorities. An AI follow-up interview digs into the specific evidence behind the employee's self-rating instead of accepting vague self-praise or self-criticism at face value. Built for HR and people managers running review or check-in cycles.

テンプレートを見る