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The instrument is for your own benefit, so be frank in your responses.
Read each statement below and indicate how much it is true of your behaviour, by using the following guidelines.
Write 4: If it is most characteristic of you, or if you always or most often behave or feel this way.
Write 3: If it is fairly true of you, or you quite often behave or feel this way.
Write 2: If it is somewhat true in your case.
Write 1: If it is not true of you, or if you only occasionally feel or behave this way.
Write 0: If it is not at all characteristic of you, or you seldom feel or behave this way.
1. I find it difficult to be frank with people unless I know them very well.
2. I listen carefully to others' opinions about my behaviour.
3. I tend to say things that turn out to be out to place.
4. Generally, I hesitate to express my feelings to others.
5. When someone directly tells me how he feels about my behaviour, I tend to close up and stop listening.
6. On hindsight, I regret why i said something tactlessly.
7. I express my opinions in a group or to a person without hesitation.
8. I take steps to find out how my behaviour has been perceived by the person with whom I have been interacting.
9. I deliberately observe how a person will take what I am going to tell him, and accordingly communicate to him.
10. When someone discusses his problems, I do not spontaneously share my experiences and personal problems, of a similar nature with him.
11. If someone criticizes me, I hear him at that time but- do not bother myself about it later.
12. I fail to pick up cues about others' feelings and reactions when i am involved in an argument or conversation.
13. I enjoy talking with others about my personal concerns and matters.
14. I value what people have to say about my style, behaviour etc
15. I am often surprised to discover (or told) that people were put off, bored or annoyed when I thought they were enjoying interacting with me.
Score sheet
For the questions that have Star(*) symbol in the response table below, use the table to reverse your response. For example, if you had originally indicated '4' as your response, look at the table and put '0' beside it. For other questions (non starred) simply write the number you had originally indicated as response to that question.
TABLE
| Original responses | Reversed responses |
| 0 | 4 |
| 1 | 3 |
| 2 | 2 |
| 3 | 1 |
| 4 | 0 |
Now, lets go to the response table. Write your response and calculate the totals for each response column.
| Item | Response | Item | Response | Item | Response |
| *1 | | 2 | | *3 | |
| *4 | | *5 | | *6 | |
| 7 | | 8 | | 9 | |
| *10 | | *11 | | *12 | |
| 13 | | 14 | | *15 | |
| Total | | | | | |
| | Self disclosure | | Openness to feedback | | Perceptiveness |
B. Write Low(L) or High(H) for each of these three total scores; If the score is 11 or below, write L; if the score is over 11 write H.
Mark one category out of the eight given below, based on the combination of your totals. This is your effectiveness type.
| Category | Self-disclosure | openness to feedback | Perceptiveness |
| Effective | High | High | High |
| Insensitive | High | High | Low |
| Egocentric | High | Low | Low |
| Dogmatic | High | Low | High |
| Secretive | Low | High | High |
| Task-obsessed | Low | High | Low |
| Lonely Empathic | Low | Low | High |
| Ineffective | Low | Low | Low |
In the table where you have filled in values (after reversing), prepare an action plan for scores equal to or below 2 to improve your behaviour and become more effective.
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