1.

Age: ______ years (compulsory)

2. Gender ____ Male ____ Female
3. Marital status: ---------
4. Education (the highest degree attained): _________________________
5. Foreign or local education:-------------
6. Mode of transportation: own----- public---- official------
7. Your position in the current organization: ________________________
8. Your tenure/experience in the current organization:______ years
9. Nature of employment? ____ Contract _____ Permanent
10. Sector of your current organization: _____ Public _____ Private

SECTION B
The following statements concern yourself in variety of situations at your workplace.
Please encircle the best option that reflects you to indicate how repeatedly you do
following activities.

Never
How often have you done each of the following things on your
present job?

Once or Twice
Once or Twice per month
Once or twice per week
Every day

1. Purposely wasted your employer’s materials/supplies 1 2 3 4 5

2. Purposely did your work incorrectly 1 2 3 4 5
3. Came to work late without permission 1 2 3 4 5
4. Stayed home from work and said you were sick when you 1 2 3 4 5
weren’t
5. Purposely damaged a piece of equipment or property 1 2 3 4 5
6. Purposely dirtied or littered your place of work 1 2 3 4 5
7. Stolen something belonging to your employer 1 2 3 4 5
 8. Started or continued a damaging or harmful rumor at work 1 2 3 4 5
9. Been nasty or rude to a client or customer 1 2 3 4 5
10. Purposely worked slowly when things needed to get done 1 2 3 4 5
11. Taken a longer break than you were allowed to take 1 2 3 4 5
12. Purposely failed to follow instructions 1 2 3 4 5
13. Left work earlier than you were allowed to 1 2 3 4 5
14. Insulted someone about their job performance 1 2 3 4 5
15. Made fun of someone’s personal life 1 2 3 4 5
16. Took supplies or tools home without permission 1 2 3 4 5
17. Put in to be paid for more hours than you worked 1 2 3 4 5
18. Took money from your employer without permission 1 2 3 4 5
19. Ignored someone at work 1 2 3 4 5
20. Blamed someone at work for error you made 1 2 3 4 5
21. Started an argument with someone at work 1 2 3 4 5
22. Stole something belonging to someone at work 1 2 3 4 5
23. Verbally abused someone at work 1 2 3 4 5
24. Made an obscene gesture (the finger) to someone at work 1 2 3 4 5
25. Threatened someone at work with violence 1 2 3 4 5
26. Threatened someone at work, but not physically 1 2 3 4 5
27. Said something obscene to someone at work to make them feel bad 1 2 3 4 5
28. Did something to make someone at work look bad 1 2 3 4 5
29. Played a mean prank to embarrass someone at work 1 2 3 4 5
30. Looked at someone at work’s private mail/property without 1 2 3 4 5
permission
31. Hit or pushed someone at work 1 2 3 4 5
32. Insulted or made fun of someone at work 1 2 3 4 5

SECTION C
Here are a number of characteristics that may or may not apply to you. For example, do you agree
that you are someone who likes to spend time with others? Please write a number next to each
statement to indicate the extent to which you agree or disagree with that statement.

Strongly          Disagree    Neither agree                        Agree    

  Strongly 
Disagree           Disagree         a little           nor disagree       Agree       a little          Agree
              
    1     2  3                     4          5               6                  7         
I see Myself as Someone Who...
____1. Is talkative ____23. Tends to be lazy
____2. Tends to find fault with others ____24. Is emotionally stable, not easily upset
____3. Does a thorough job ____25. Is inventive
____4. Is depressed, blue ____26. Has an assertive personality
____5. Is original, comes up with new ideas ____27. Can be cold and aloof
____6. Is reserved ____28. Perseveres until the task is finished
____7. Is helpful and unselfish with others ____29. Can be moody
____8. Can be somewhat careless ____30. Values artistic, aesthetic experiences
____9. Is relaxed, handles stress well ____31. Is sometimes shy, inhibited
____10. Is curious about many different things

____32. Is considerate and kind to almost everyone

____11. Is full of energy
____12. Starts quarrels with others
____13. Is a reliable worker
____14. Can be tense
____15. Is ingenious, a deep thinker
____16. Generates a lot of enthusiasm
____17. Has a forgiving nature
____18. Tends to be disorganized
____19. Worries a lot
____20. Has an active imagination
____21. Tends to be quiet
____22. Is generally trusting
____33. Does things efficiently
____34. Remains calm in tense situations
____35. Prefers work that is routine
____36. Is outgoing, sociable
____37. Is sometimes rude to others
___38. Makes plans and follows through with them
____39. Gets nervous easily
____40. Likes to reflect, play with ideas
____41. Have few artistic interests
____42. Likes to cooperate with others
____43. Is easily distracted
____44. Is sophisticated in art, music, or literature