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Age: __________ years Gender: M / F

1. Qualification: (years of Employment)

I.m aess than 5 years


II.m 10 years
III.m 15 years or more

2. You have been in this organization for:

I.m aess than 2 years


II.m More than 2 but less than 5 years
III.m More than 5 years

  
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0. Did you Adjusted your work schedule to accommodate other employees' requests for time off.

I.m Yes II. No

4. Did you Helped others who have been absent.

I.m Yes II. No

5. Showed genuine concern and courtesy toward coworkers, even under the most trying business or
personal situations.

I.m Yes II. No

6. Offered ideas to improve the functioning of the organization.

I.m Yes II. No

7. Expressed loyalty toward the organization.

I.m Yes II. No

8. Taken action to protect the organization from potential problems.

I.m Yes II. No

9. Demonstrated concern about the image of the organization.

I.m Yes II. No

10. Took the initiative to troubleshoot and solve technical problems before requesting help from a
supervisor.

I.m Yes II. No


11. Voluntarily did more than the job requires so that I can help others or contribute to the overall
functioning of the facility.

I.m Yes II. No

   

12. Willingly give of my time to help others out who have work-related problems.

I.m Yes II. No

10. I am willing to take time out of my busy schedule to help with recruiting or training new employees.

I.m Yes II. No

14. Rarely takes long lunches or breaks.

I.m Yes II. No

15. Does not take unnecessary time off work.

I.m Yes II. No

16. Does not take extra breaks.

I.m Yes II. No

17. Attendance at work is above the norm.

I.m Yes II. No

18. Obeys company rules and regulations even when no one is watching.

I.m Yes II. No

19. I attend functions that are not required but help the company͛s image.

I.m Yes II. No

20. I attend training/information sessions that I am encouraged to, but not required to attend.

I.m Yes II. No

21. I attend and actively participate in company meetings.

1 Never 2 Seldom 0 Sometimes 4 Often 5 Always