LEVEL OF SELF-ESTEEM TOWARDS PERCEPTION OF HEALTHCARE PROVIDER

NAME (optional):_________________________________
Grade & Section:____________________________________
Direction: Please check the appropriate answer that fits work requirements and positive response
due to the following factors. Answer the questions by checking the degree of your choice.

INFLATED ALWAYS OFTEN SOMETIMES RARELY NEVER

SELF-ESTEEM 5 4 3 2 1

As an employee
In this service
industry I find
That,

1.I feel anxious

When meeting
new people
.
2.I take a
positive attitude
towards myself

3.I feel that

some other
people doesn’t
like me.

4. I easily get
hurt when
someone
corrects me.
5.I avoided
conversation
when meeting
new people.

HIGH ALWAYS OFTEN SOMETIMES RARELY NEVER

SELF-ESTEEM 5 4 3 2 1
As an employee
in
this service
industry
I am able to do
things as well as
most other
people.
2. I am satisfied
With myself.
3. I think I am
good for all of
my colleagues.

4. I fell I have a
good number of
qualities.

5. I feel I am a
person of worth

LOW ALWAYS OFTEN SOMETIMES RARELY NEVER

SELF-ESTEEM 5 4 3 2 1
As an employee
In this industry
1.I feel I am a
failure when my
patient/resident
didn’t get well
2.At times I
think I am no
good at all
3.I feel I do not
have much to
be proud in this
industry.
Pp4.People
would
Criticize easily
for what I say or
do.
5. I am
embarrassed
easily when my
pears laughed
at my mistakes.