Your name: ___________________________ Date:_______________________________
Person whose contribution you are rating:______________
Other person or persons in the relationship:_____________
10=Extremely often
8= Very often
6=Fairly Often
4=Sometimes but not very often
2=Very seldom
0=Never
Please rate how often the person:
_____ 1. Gives approval, praise, compliments, congratulations, shows appreciation
_____ 2. Is a good listener.
_____ 3. Uses pleasant and enthusiastic tones of voice.
_____ 4. Contributes to a fun and interesting conversation.
_____ 5. Makes it enjoyable for the other or others to spend time with the person.
_____ 6. Seems to feel good, rather than jealous, about the other person's good fortune or success.
_____ 7. Speaks respectfully and politely.
_____ 8. Is willing to help out with work that needs to be done.
_____ 9. Seems cheerful and upbeat.
_____ 10. Gets very upset over very little things.
_____ 11. Expresses criticism, disapproval, correction, or insult.
_____ 12. Acts bossy.
_____ 13. Withdraws and avoids interacting when it doesn't help the relationship to do so. .
_____ 14. Contradicts the other person, points out how they are wrong.
_____ 15. Raises the voice in anger at the other
Of the comments this person makes that are approving or disapproving of the other, or others, what percent, approximately, are approving? ________________