This is to measure our progress before we start working together and then at 3 and 6 monthly intervals.

   1. Identify and fill in as many areas that are relevant to you
   2. Describe the issue in the 'Category' column
   3. Rate the issue 0-5 (0=none, 1=low, 5=high) in the Current State column
   4. Add any other comments under the numbered boxes
   5. Please return the form prior to commencement