Very

Poor

Poor

Fair

Good

Very

Good

Out-standing

Category 1

I show kindness and consideration toward others

1

2

3

4

5

6

I keep promises and honor commitments

1

2

3

4

5

6

I do not speak negatively of others when they are not present

1

2

3

4

5

6

Category 2

I am able to maintain an appropriate balance among the various aspects of my life—work, family, friends, etc.

1

2

3

4

5

6

When working on a task, I also keep in mind the concerns and needs of those I am working for

1

2

3

4

5

6

I work hard at the things I do, but not in a manner that causes burnout

1

2

3

4

5

6

Category 3

I am in control of my life

1

2

3

4

5

6

I focus my efforts on the things I can do something about rather than on the things beyond my control

1

2

3

4

5

6

I take responsibility for my moods and actions rather than blame others and circumstances

1

2

3

4

5

6

Category 4

I know what I want to accomplish in life

1

2

3

4

5

6

I organize and prepare in a way that reduces having to work in a crisis mode

1

2

3

4

5

6

I begin each week with a clear plan of what I desire to accomplish

1

2

3

4

5

6

Category 5

I am disciplined in carrying out plans (avoiding procrastination, time wasters, and so forth)

1

2

3

4

5

6

I do not allow the truly important activities of my life to get lost in the busy activity of my days

1

2

3

4

5

6

The things that I do every day are meaningful and contribute to my overall goals in life

1

2

3

4

5

6

Category 6

I care about the success of others as well as my own

1

2

3

4

5

6

I cooperate with others

1

2

3

4

5

6

When solving conflicts, I strive to find solutions that benefit all

1

2

3

4

5

6

Very

Poor

Poor

Fair

Good

Very

Good

Out-standing

Category 7

I am sensitive to the feelings of others

1

2

3

4

5

6

I seek to understand the viewpoints of others

1

2

3

4

5

6

When listening, I try to see things from the other person’s point of view, not just my own

1

2

3

4

5

6

Category 8

I value and seek out the insights of others

1

2

3

4

5

6

I am creative in searching for new and better ideas and solutions

1

2

3

4

5

6

I encourage others to express their opinions

1

2

3

4

5

6

Category 9

I care for my physical health and well-being

1

2

3

4

5

6

I strive to build and improve relationships with others

1

2

3

4

5

6

I take time to find meaning and enjoyment in life

1

2

3

4

5

6

1

2

3

4

5

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