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If you have NOT performed a task before, estimate how difficult the task would be for you

to learn to perform.

Circle the number on the scale that you believe comes closed to your skill or task level. Be
honest about your choices as there are no right or wrong answers – it is only for your own self-

assessment.

Very Moderately Adequate Moderately Very
strong strong weak weak
1. I enjoy communicating with 5 4 3 2 1
others.
2. I am honest and fair. 5 4 3 2 1
3. I make decisions with input from 5 4 3 2 1
others.
4. My actions are consistent. 5 4 3 2 1
5. I give others the information they 5 4 3 2 1
need to do their jobs.
6. I keep focused through follow- 5 4 3 2 1
up.
7. I listen to feedback and ask 5 4 3 2 1
questions.
8. I show loyalty to the company 5 4 3 2 1
and to the team members.
9. I create an atmosphere of growth. 5 4 3 2 1
10. I have wide visibility. 5 4 3 2 1
11. I give praise and recognition. 5 4 3 2 1
12. I criticize constructively and 5 4 3 2 1
address problems.
13. I develop plans. 5 4 3 2 1
14. I have a vision on where we are 5 4 3 2 1
going and set long-term goals.
15. I set objectives and follow them 5 4 3 2 1
through to completion.
16. I display tolerance and flexibility. 5 4 3 2 1
17. I can be assertive when needed. 5 4 3 2 1
18. I am a Champion of change. 5 4 3 2 1
19. I treat others with respect and 5 4 3 2 1
dignity.
20. I make myself available and 5 4 3 2 1
accessible.
21. I want to take charge. 5 4 3 2 1
22. I accept ownership for team 5 4 3 2 1
decisions.
23. I set guidelines for how others are 5 4 3 2 1
to treat one another.
24. I manage by “walking around” 5 4 3 2 1
(the front line is the bottom line).
25. I am close to the business and 5 4 3 2 1