Executive Coaching Worksheet

Table of Contents

1. FOCUS Model

2. Executive Coaching Agreement

3. Executive Coaching Plan

4. Coaching Session Progress Notes

5. Action Plan

6. Executive Coach Form

7. Client Form

8. Executive Coaching Plan Review

The FOCUS Model of Coaching (developed by Victor Harms, Ph.D)
James Roemmich

F = Formulate relationship, expectations, issues, questions, process, and personality style.

Skills/Process: Active listening, open and closed-ended questions.

O = Organize priorities, values, goals (situational and life-long)

Skills/Process: Synthesis, prioritization, sorting and defining

C = Clarify define direction, process, intended outcomes,

Skills/Process: Questions, reframing, feedback, selecting and paraphrasing

U = Utilize identify and apply active and/or latent client resources, other resources such as
new skills and new knowledge
Skills/Process: Strengths identification, reframing and directing

S = Sequence detailed steps including time table, order of occurrence, and specific
celebration upon completion
Skills/Process: Logic, problem solving and drawing connections

There is a logical progression from the first item to the fifth item. There is also a compounding
aspect to the model. When you gain additional information on any level, there is the need to
cycle back to the previous steps and reassess the previous information and incorporate it within
the process.
 Executive Coaching Agreement

I, ______________________, agree to the following conditions of the Executive Coaching

process with ____________James Roemmich____________________.

I understand that I am receiving Executive Coaching and not mental health counseling.

Executive Coaching is a facilitation process for healthy people in the identification, selection and

achievement of personal and professional goals.

I understand that the Executive Coaching information from my sessions will be kept confidential.

I also agree to allow results of the Executive Coaching process to be used for education and

research purposes. My identity, name and any other identifiable personal information, will be

kept confidential.

I commit to attend my sessions on time and I will do my assignments. I also agree to fill out all

of the forms and surveys in the Executive Coaching process.

Fee Schedule:
$65 per 30-minute session ($120 per full hour)
$30 per 30-minute session ($60 per full hour) (Student Rate)
To be paid in full at conclusion of each session (cash or check made out to James Roemmich)

____________________ __________________________________
(Date) (Coaching Client)

___________________ __________________________________
(Date) (Executive Coach James Roemmich)
Executive Coaching Plan Name________________

Name of Coach ____James Roemmich_______

1. What is your coaching goal? (25 words or less)

2. How does this executive coaching goal match up to your life priorities, life values and
life goals?

Priorities (what do you need to work on right now)

Values (what things are most important to you)

Life goals (where you want to end up)

3. What are the details of your coaching goal? (Where, when, what, how and who)

4. What resources will you need in order to complete your coaching goal?
(Knowledge, skill, materials, people and money)

5. What are the steps that need to be done in order for you to reach your goal? What is the
order that you need to do the steps? (First, second, third)

6. How will you reward yourself when you complete each of the steps? (What is
something you can do for yourself after you do each of the steps?)
Coaching Session Progress Notes Client Name________________

Name of Coach _James Roemmich_____________

Session One Date ____________________

Action Plan ________________________________________________________

__________________________________________________________________

__________________________________________________________________

Session Two Date _________________

Action Plan ________________________________________________________

__________________________________________________________________

__________________________________________________________________

Session Three Date ____________________

 Action Plan ________________________________________________________

__________________________________________________________________

__________________________________________________________________

Session Four Date ____________________

Action Plan ________________________________________________________

__________________________________________________________________

__________________________________________________________________

Session Five Date ____________________

Action Plan ________________________________________________________

__________________________________________________________________

__________________________________________________________________
Action Plan

I, ______________________, commit to do the following actions:

_____________________________________________________________________
(Actions)

by the time of my next Executive Coaching Session.

My next Executive Coaching session is on_____________________________________.

Signed _____________________________________ date_____________

Witnessed __________________________________ date______________

James Roemmich
 Executive Coach Response Form

Response Form for Coaching Sessions Name of Client_______

Name of Coach ___James Roemmich___

(Circle one number for each question)

1. The client was very engaged during the coaching session.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6

2. The client was very open to the feedback that the coach gave.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6
3. The client was able to actively choose their coaching goal.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6

4. The client has a good plan to begin their coaching goal.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6

5. The client is really motivated to do their coaching plan.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6
6. The client chose a good reward for completing the steps of the coaching plan.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6
 Client Response Form

Feedback Form for Coaching Sessions Name of Client______

Name of Coach ___James Roemmich___

(Circle one number for each question)

1. My coach was very engaged during coaching session.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6

2. The feedback that my coach gave me was very beneficial.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6
3. The executive coach helped me choose my coaching goal.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6

4. I have a plan to begin the coaching goal.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6

5. I am really motivated to do my coaching plan.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6
6. My coach helped me choose a reward for doing each step of the coaching plan.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6
Client Coaching Plan Review Client Name ______________

Name of Coach ___James Roemmich_________

1. What was your executive coaching goal? (25 words or less)

2. How did this coaching goal match up to your life priorities, life values and life
goals?

Priorities (what do you need to work on right now)

Values (what things are most important to you)

Life goals (where you want to end up)

3. What where the details of your coaching goal? (Where, when, what, how and who)

4. What resources did you need in order to complete your coaching goal?
(Knowledge, skill, materials, people and money)

5. What were the steps that needed to be done in order for you to reach your goal? What
was the order that you needed to do the steps? (First, second, third)

6. How did you reward yourself when you completed each of the steps? (What were
the things you did for yourself after you did each of the steps?)