Executive function assessment template for the workplace

Key takeaways

This template is a 36-item self-assessment adults use to rate their own executive function skills at work.

It scores 12 domains, from response inhibition and working memory to time management and stress tolerance.

Each domain gets three statements rated 1 to 5, so results show a pattern of strengths and weaknesses, not one single score.

It suits occupational health intake, ADHD-in-adults workflows, and executive coaching baselines, not pediatric evaluation.

Pabau’s client records keep the completed checklist and your notes on it together in one place.

A capable employee misses two deadlines in one week, then forgets a promised callback entirely. Nothing about their intelligence changed. What likely shifted is executive function, the mental skill set that governs focus, planning, and follow-through under pressure.

Practices working with adults, across occupational health, ADHD-in-adults intake, or executive coaching, need a fast way to capture that picture. This free executive function assessment template does exactly that. It’s a 36-item self-report checklist, and practice management software like Pabau can store it right alongside every other intake form.

What does this executive function assessment measure?

This template is a 36-statement, adult self-report checklist that scores 12 workplace executive function skills on a 1-to-5 scale. Executive function is the mental skill set behind starting tasks, holding information in mind, and adjusting when plans change.

Plenty of executive function tools exist for children. The best known is the BRIEF-2, a caregiver-rated questionnaire built for pediatric ADHD workups. This template is different. An adult completes it themselves, and every item is framed around workplace behavior, not classroom behavior.

Executive function measurement usually falls into three formats: timed performance tests, observer rating scales, and self-report checklists like this one. Self-report works well for adults who can reflect on their own habits. It isn’t a stand-alone diagnostic tool though.

The 12 domains this checklist scores

Each of the 12 domains gets three statements, so the full checklist runs to 36 items. Every item uses the same 1-to-5 agreement scale, from strongly disagree to strongly agree. Add the three scores per domain together for one section total.

All 12 domains at a glance

How this compares with pediatric tools

Notice how broad this list is next to the BRIEF-2, a pediatric tool with 9 clinical scales across 3 indexes. The extra domains, like acute stress tolerance and goal-directed persistence, reflect demands a workplace creates that a classroom simply doesn’t.

How the scoring works, section by section

A few questions come up often once practices start using this template.

How is each domain scored?

Add the three 1-to-5 ratings in a domain together. That gives a section score between 3 and 15.

What happens after all 12 sections?

The next page pulls every section score into one summary grid, so all 12 appear side by side.

Does the template give cutoffs, like “at risk” or “clinically significant”?

No. It’s a reflection tool, not a normed clinical instrument, so there’s no population cutoff built in. Read the pattern across domains instead of any single number.

What’s on the very last page?

Two open text boxes: Strengths and Weaknesses. The client fills these in before you discuss the results together.

Who actually uses a workplace executive function checklist?

Four practice types reach for this template most often.

• Occupational health teams, working through a return-to-work case or a workplace accommodation request.
• ADHD-in-adults workflows, where the checklist adds a self-report layer next to the clinical interview, not instead of it.
• Executive and workplace coaches, using the scores as a baseline before a coaching program starts.
• EAP-style practices, screening for the executive strain that shows up as missed deadlines or friction with a manager.

None of these replace a formal diagnostic workup. Clinicians building that workup often keep a neuro exam cheat sheet on hand for the neurological side of the assessment. What the checklist does is give everyone in the room the same starting language before that deeper conversation happens.

Giving this checklist without derailing an intake session

Handing over 36 statements sounds like it could eat into a session. It doesn’t, if you build it into the workflow properly.

1. Send it before the appointment. Ask the client to complete all 36 items ahead of their first full session, not during it.
2. Budget 10 to 15 minutes. That’s the average time most adults need for 36 short statements.
3. Skip explaining the “right” answer. There isn’t one, only an honest self-rating.
4. Add up each section. Twelve totals, each between 3 and 15, transferred onto the summary grid.
5. Read the strengths and weaknesses pages first. They usually say more than the numbers alone.

Before you hand this to a client, run through a quick check:

• Confirm the client is rating themselves, not a manager or partner rating them.
• Check they’ve had a full page to reflect on strengths and weaknesses, not just the number grid.
• File the completed PDF in the client record straight away, before it lands on someone’s desk instead.

The most common mistake is treating one low section score as a diagnosis. A single domain reflects three statements and nothing more. Look for a pattern across several domains first, then talk it through with the client.

What you get out of scoring it properly

• Fast to complete. Thirty-six short statements take most adults 10 to 15 minutes, so the checklist fits inside a standard intake slot.
• Covers the full picture. Twelve domains mean you’re not judging focus or time management in isolation. You’re seeing how they interact.
• Gives coaching conversations a starting point. A strong organization score paired with a weak stress-tolerance score points straight at where to focus first. A conversation skills worksheet often helps structure that follow-up when the weak domain shows up as friction with colleagues.
• Creates a paper trail for accommodation requests. A dated, documented checklist in the client file is useful evidence when someone explores a workplace adjustment.
• Complements clinical measures, rather than replacing them. Self-report data adds the client’s own perspective on top of whatever else your intake already gathers. Some practices pair it with a targeted tool, like an impostor syndrome test, when self-doubt is the presenting concern.

How Pabau keeps the results part of the record

Most practices running a checklist like this end up with a scanned PDF in one folder. The notes land in another. That’s fine, until someone else on the team needs the full picture fast.

Practice management software like Pabau keeps the completed assessment, the section scores, and your clinical notes on one client record. Upload the signed PDF once, and it sits next to the intake form and every session note that follows.

Echo AI, Pabau’s AI scribe, can turn your spoken read of the strengths and weaknesses pages into a structured note. It takes seconds, not minutes. When a manager, occupational health provider, or coach needs an update, you export the record. There’s no need to hunt for an attachment.

Keep every executive function checklist in one record

Pabau's client records and Echo AI store completed assessments, section scores, and follow-up notes in one place, so nothing gets lost between sessions.

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Conclusion

A 36-item checklist won’t diagnose anyone. What it does is turn a vague sense that something’s off at work into 12 concrete scores worth discussing.

Treat it as a starting point, not a verdict. Pair the numbers with a real conversation. Revisit the strengths and weaknesses pages whenever a client’s role or workload shifts.

Once these checklists become routine, storing them by hand stops scaling. Book a demo to see how Pabau keeps every assessment, score, and note together in one client record.

Continue your research

Need documentation that holds up to scrutiny? Safer clinical notes covers habits that keep assessment write-ups defensible.

Need a broader intake structure to slot this into? Psychiatric evaluation template covers a full intake flow built around the same client record.

Need consent language before you assess someone? Group therapy informed consent template adapts easily to explain how you will use the results.

Frequently asked questions