Not sure how one might use such a thing, for our own private use perhaps, something we might post on a blog if you have one or respond to in comments, anonymously perhaps to avoid ego issues, whether here or through email which I could then post if you so wished.
And perhaps it's too long, could be used as a framework of sample questions, some you might feel like answering, others not.
And some links to a couple of bloggers who have tried it out.
Micqui at Ashtanga Angel
Rani at Yoga Junky
and another one at Ro's place (who has a blog title even longer than mine 'Yoga Every Day (except Saturdays and Moon Days)'