Caregiver Assessment – Independent Refuge

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Thank you for your interest in participating in the Independent Refuge's caregiver program. The following assessment will assist you and our home-care partners in confirming that you are a good fit for a caretaking position. It is important that you answer all questions honestly and accurately. This is the only way to know that you will be happy and successful in a caregiver job.

Please use a computer or tablet to complete this assessment. The assessment is more difficult when completed on your mobile phone.

Applicant Details

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Below you will see a list of a variety of items. Rate each item according to how much it disturbs or disgusts you. *

	Doesn't bother me at all	Bother's me a little	Neutral	Disgusts me a little	Totally disgusts or disturbs me
Seeing a person who is in great physical pain.	Doesn't bother me at allSeeing a person who is in great physical pain. Doesn't bother me at all	Bother's me a littleSeeing a person who is in great physical pain. Bother's me a little	NeutralSeeing a person who is in great physical pain. Neutral	Disgusts me a littleSeeing a person who is in great physical pain. Disgusts me a little	Totally disgusts or disturbs meSeeing a person who is in great physical pain. Totally disgusts or disturbs me
Seeing a person who is in great emotional pain.	Doesn't bother me at allSeeing a person who is in great emotional pain. Doesn't bother me at all	Bother's me a littleSeeing a person who is in great emotional pain. Bother's me a little	NeutralSeeing a person who is in great emotional pain. Neutral	Disgusts me a littleSeeing a person who is in great emotional pain. Disgusts me a little	Totally disgusts or disturbs meSeeing a person who is in great emotional pain. Totally disgusts or disturbs me
Cleaning up vomit.	Doesn't bother me at allCleaning up vomit. Doesn't bother me at all	Bother's me a littleCleaning up vomit. Bother's me a little	NeutralCleaning up vomit. Neutral	Disgusts me a littleCleaning up vomit. Disgusts me a little	Totally disgusts or disturbs meCleaning up vomit. Totally disgusts or disturbs me
Watching someone vomit.	Doesn't bother me at allWatching someone vomit. Doesn't bother me at all	Bother's me a littleWatching someone vomit. Bother's me a little	NeutralWatching someone vomit. Neutral	Disgusts me a littleWatching someone vomit. Disgusts me a little	Totally disgusts or disturbs meWatching someone vomit. Totally disgusts or disturbs me
Changing bandages on an infected wound.	Doesn't bother me at allChanging bandages on an infected wound. Doesn't bother me at all	Bother's me a littleChanging bandages on an infected wound. Bother's me a little	NeutralChanging bandages on an infected wound. Neutral	Disgusts me a littleChanging bandages on an infected wound. Disgusts me a little	Totally disgusts or disturbs meChanging bandages on an infected wound. Totally disgusts or disturbs me
Taking someone's blood or watching it being taken.	Doesn't bother me at allTaking someone's blood or watching it being taken. Doesn't bother me at all	Bother's me a littleTaking someone's blood or watching it being taken. Bother's me a little	NeutralTaking someone's blood or watching it being taken. Neutral	Disgusts me a littleTaking someone's blood or watching it being taken. Disgusts me a little	Totally disgusts or disturbs meTaking someone's blood or watching it being taken. Totally disgusts or disturbs me
Changing an elderly person's diaper.	Doesn't bother me at allChanging an elderly person's diaper. Doesn't bother me at all	Bother's me a littleChanging an elderly person's diaper. Bother's me a little	NeutralChanging an elderly person's diaper. Neutral	Disgusts me a littleChanging an elderly person's diaper. Disgusts me a little	Totally disgusts or disturbs meChanging an elderly person's diaper. Totally disgusts or disturbs me
Being around a person who has body odor due to a medical condition.	Doesn't bother me at allBeing around a person who has body odor due to a medical condition. Doesn't bother me at all	Bother's me a littleBeing around a person who has body odor due to a medical condition. Bother's me a little	NeutralBeing around a person who has body odor due to a medical condition. Neutral	Disgusts me a littleBeing around a person who has body odor due to a medical condition. Disgusts me a little	Totally disgusts or disturbs meBeing around a person who has body odor due to a medical condition. Totally disgusts or disturbs me
Talking to someone with a severe disfigurement.	Doesn't bother me at allTalking to someone with a severe disfigurement. Doesn't bother me at all	Bother's me a littleTalking to someone with a severe disfigurement. Bother's me a little	NeutralTalking to someone with a severe disfigurement. Neutral	Disgusts me a littleTalking to someone with a severe disfigurement. Disgusts me a little	Totally disgusts or disturbs meTalking to someone with a severe disfigurement. Totally disgusts or disturbs me

To what degree would you be capable of dealing with the following physical tasks related to caregiving: *

	Very capable	Fairly capable	Somewhat capable	Not very capable	Not at all capable
Standing for long periods of time.	Very capableStanding for long periods of time. Very capable	Fairly capableStanding for long periods of time. Fairly capable	Somewhat capableStanding for long periods of time. Somewhat capable	Not very capableStanding for long periods of time. Not very capable	Not at all capableStanding for long periods of time. Not at all capable
Walking for long periods of time.	Very capableWalking for long periods of time. Very capable	Fairly capableWalking for long periods of time. Fairly capable	Somewhat capableWalking for long periods of time. Somewhat capable	Not very capableWalking for long periods of time. Not very capable	Not at all capableWalking for long periods of time. Not at all capable
Lifting patients (in and out of bed, bathtub, wheelchair, etc.).	Very capableLifting patients (in and out of bed, bathtub, wheelchair, etc.). Very capable	Fairly capableLifting patients (in and out of bed, bathtub, wheelchair, etc.). Fairly capable	Somewhat capableLifting patients (in and out of bed, bathtub, wheelchair, etc.). Somewhat capable	Not very capableLifting patients (in and out of bed, bathtub, wheelchair, etc.). Not very capable	Not at all capableLifting patients (in and out of bed, bathtub, wheelchair, etc.). Not at all capable
Working long hours.	Very capableWorking long hours. Very capable	Fairly capableWorking long hours. Fairly capable	Somewhat capableWorking long hours. Somewhat capable	Not very capableWorking long hours. Not very capable	Not at all capableWorking long hours. Not at all capable

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Who often do the following statements apply to you? *

	Most of the time	Often	Sometimes	Rarely	Almost never
I keep my cool when I'm angry or frustrated.	Most of the timeI keep my cool when I'm angry or frustrated. Most of the time	OftenI keep my cool when I'm angry or frustrated. Often	SometimesI keep my cool when I'm angry or frustrated. Sometimes	RarelyI keep my cool when I'm angry or frustrated. Rarely	Almost neverI keep my cool when I'm angry or frustrated. Almost never
I feel comfortable saying "no" to people.	Most of the timeI feel comfortable saying "no" to people. Most of the time	OftenI feel comfortable saying "no" to people. Often	SometimesI feel comfortable saying "no" to people. Sometimes	RarelyI feel comfortable saying "no" to people. Rarely	Almost neverI feel comfortable saying "no" to people. Almost never
I have a hard time keeping secrets.	Most of the timeI have a hard time keeping secrets. Most of the time	OftenI have a hard time keeping secrets. Often	SometimesI have a hard time keeping secrets. Sometimes	RarelyI have a hard time keeping secrets. Rarely	Almost neverI have a hard time keeping secrets. Almost never
I finish what I set out to do.	Most of the timeI finish what I set out to do. Most of the time	OftenI finish what I set out to do. Often	SometimesI finish what I set out to do. Sometimes	RarelyI finish what I set out to do. Rarely	Almost neverI finish what I set out to do. Almost never
I check over my paperwork carefully.	Most of the timeI check over my paperwork carefully. Most of the time	OftenI check over my paperwork carefully. Often	SometimesI check over my paperwork carefully. Sometimes	RarelyI check over my paperwork carefully. Rarely	Almost neverI check over my paperwork carefully. Almost never
I enjoy working in a team.	Most of the timeI enjoy working in a team. Most of the time	OftenI enjoy working in a team. Often	SometimesI enjoy working in a team. Sometimes	RarelyI enjoy working in a team. Rarely	Almost neverI enjoy working in a team. Almost never
I can find something positive in even the most difficult situations.	Most of the timeI can find something positive in even the most difficult situations. Most of the time	OftenI can find something positive in even the most difficult situations. Often	SometimesI can find something positive in even the most difficult situations. Sometimes	RarelyI can find something positive in even the most difficult situations. Rarely	Almost neverI can find something positive in even the most difficult situations. Almost never
I have healthy eating habits.	Most of the timeI have healthy eating habits. Most of the time	OftenI have healthy eating habits. Often	SometimesI have healthy eating habits. Sometimes	RarelyI have healthy eating habits. Rarely	Almost neverI have healthy eating habits. Almost never
I work persistently until my task is complete.	Most of the timeI work persistently until my task is complete. Most of the time	OftenI work persistently until my task is complete. Often	SometimesI work persistently until my task is complete. Sometimes	RarelyI work persistently until my task is complete. Rarely	Almost neverI work persistently until my task is complete. Almost never

Who often do the following statements apply to you? (continued) *

	Most of the time	Often	Sometimes	Rarely	Almost never
I pay careful attention to small details when I'm completing a task.	Most of the timeI pay careful attention to small details when I'm completing a task. Most of the time	OftenI pay careful attention to small details when I'm completing a task. Often	SometimesI pay careful attention to small details when I'm completing a task. Sometimes	RarelyI pay careful attention to small details when I'm completing a task. Rarely	Almost neverI pay careful attention to small details when I'm completing a task. Almost never
I refuse to give up, no matter how tough things get.	Most of the timeI refuse to give up, no matter how tough things get. Most of the time	OftenI refuse to give up, no matter how tough things get. Often	SometimesI refuse to give up, no matter how tough things get. Sometimes	RarelyI refuse to give up, no matter how tough things get. Rarely	Almost neverI refuse to give up, no matter how tough things get. Almost never
I show up when I say I will.	Most of the timeI show up when I say I will. Most of the time	OftenI show up when I say I will. Often	SometimesI show up when I say I will. Sometimes	RarelyI show up when I say I will. Rarely	Almost neverI show up when I say I will. Almost never
I avoid expressing my disagreement with people because they might get angry with me.	Most of the timeI avoid expressing my disagreement with people because they might get angry with me. Most of the time	OftenI avoid expressing my disagreement with people because they might get angry with me. Often	SometimesI avoid expressing my disagreement with people because they might get angry with me. Sometimes	RarelyI avoid expressing my disagreement with people because they might get angry with me. Rarely	Almost neverI avoid expressing my disagreement with people because they might get angry with me. Almost never
When trying to explain something complex, I ask my listeners if they are following me.	Most of the timeWhen trying to explain something complex, I ask my listeners if they are following me. Most of the time	OftenWhen trying to explain something complex, I ask my listeners if they are following me. Often	SometimesWhen trying to explain something complex, I ask my listeners if they are following me. Sometimes	RarelyWhen trying to explain something complex, I ask my listeners if they are following me. Rarely	Almost neverWhen trying to explain something complex, I ask my listeners if they are following me. Almost never
I find it difficult to prioritize my tasks.	Most of the timeI find it difficult to prioritize my tasks. Most of the time	OftenI find it difficult to prioritize my tasks. Often	SometimesI find it difficult to prioritize my tasks. Sometimes	RarelyI find it difficult to prioritize my tasks. Rarely	Almost neverI find it difficult to prioritize my tasks. Almost never
I am able to motivate myself to complete unpleasant but necessary tasks.	Most of the timeI am able to motivate myself to complete unpleasant but necessary tasks. Most of the time	OftenI am able to motivate myself to complete unpleasant but necessary tasks. Often	SometimesI am able to motivate myself to complete unpleasant but necessary tasks. Sometimes	RarelyI am able to motivate myself to complete unpleasant but necessary tasks. Rarely	Almost neverI am able to motivate myself to complete unpleasant but necessary tasks. Almost never
I work more slowly than most people.	Most of the timeI work more slowly than most people. Most of the time	OftenI work more slowly than most people. Often	SometimesI work more slowly than most people. Sometimes	RarelyI work more slowly than most people. Rarely	Almost neverI work more slowly than most people. Almost never
I make a conscious effort to follow the rules and regulations of my workplace.	Most of the timeI make a conscious effort to follow the rules and regulations of my workplace. Most of the time	OftenI make a conscious effort to follow the rules and regulations of my workplace. Often	SometimesI make a conscious effort to follow the rules and regulations of my workplace. Sometimes	RarelyI make a conscious effort to follow the rules and regulations of my workplace. Rarely	Almost neverI make a conscious effort to follow the rules and regulations of my workplace. Almost never

Who often do the following statements apply to you? (continued) *

	Most of the time	Often	Sometimes	Rarely	Almost never
I can accurately estimate the amount of time that a task will take.	Most of the timeI can accurately estimate the amount of time that a task will take. Most of the time	OftenI can accurately estimate the amount of time that a task will take. Often	SometimesI can accurately estimate the amount of time that a task will take. Sometimes	RarelyI can accurately estimate the amount of time that a task will take. Rarely	Almost neverI can accurately estimate the amount of time that a task will take. Almost never
I can calm myself down when I'm under stress.	Most of the timeI can calm myself down when I'm under stress. Most of the time	OftenI can calm myself down when I'm under stress. Often	SometimesI can calm myself down when I'm under stress. Sometimes	RarelyI can calm myself down when I'm under stress. Rarely	Almost neverI can calm myself down when I'm under stress. Almost never
I miss deadlines.	Most of the timeI miss deadlines. Most of the time	OftenI miss deadlines. Often	SometimesI miss deadlines. Sometimes	RarelyI miss deadlines. Rarely	Almost neverI miss deadlines. Almost never
When I finish an assignment, it is free of errors.	Most of the timeWhen I finish an assignment, it is free of errors. Most of the time	OftenWhen I finish an assignment, it is free of errors. Often	SometimesWhen I finish an assignment, it is free of errors. Sometimes	RarelyWhen I finish an assignment, it is free of errors. Rarely	Almost neverWhen I finish an assignment, it is free of errors. Almost never
I keep an agenda or electronic organizer handy to jot down ideas and reminders.	Most of the timeI keep an agenda or electronic organizer handy to jot down ideas and reminders. Most of the time	OftenI keep an agenda or electronic organizer handy to jot down ideas and reminders. Often	SometimesI keep an agenda or electronic organizer handy to jot down ideas and reminders. Sometimes	RarelyI keep an agenda or electronic organizer handy to jot down ideas and reminders. Rarely	Almost neverI keep an agenda or electronic organizer handy to jot down ideas and reminders. Almost never
I manage to explain my ideas clearly.	Most of the timeI manage to explain my ideas clearly. Most of the time	OftenI manage to explain my ideas clearly. Often	SometimesI manage to explain my ideas clearly. Sometimes	RarelyI manage to explain my ideas clearly. Rarely	Almost neverI manage to explain my ideas clearly. Almost never
I find it difficult to express my opinions when others don't share them.	Most of the timeI find it difficult to express my opinions when others don't share them. Most of the time	OftenI find it difficult to express my opinions when others don't share them. Often	SometimesI find it difficult to express my opinions when others don't share them. Sometimes	RarelyI find it difficult to express my opinions when others don't share them. Rarely	Almost neverI find it difficult to express my opinions when others don't share them. Almost never
I take simple precautions so that I can prevent accidents from occurring.	Most of the timeI take simple precautions so that I can prevent accidents from occurring. Most of the time	OftenI take simple precautions so that I can prevent accidents from occurring. Often	SometimesI take simple precautions so that I can prevent accidents from occurring. Sometimes	RarelyI take simple precautions so that I can prevent accidents from occurring. Rarely	Almost neverI take simple precautions so that I can prevent accidents from occurring. Almost never
When I don't understand a question, I ask for an additional explanation.	Most of the timeWhen I don't understand a question, I ask for an additional explanation. Most of the time	OftenWhen I don't understand a question, I ask for an additional explanation. Often	SometimesWhen I don't understand a question, I ask for an additional explanation. Sometimes	RarelyWhen I don't understand a question, I ask for an additional explanation. Rarely	Almost neverWhen I don't understand a question, I ask for an additional explanation. Almost never
I consider how others will be affected by my words and actions.	Most of the timeI consider how others will be affected by my words and actions. Most of the time	OftenI consider how others will be affected by my words and actions. Often	SometimesI consider how others will be affected by my words and actions. Sometimes	RarelyI consider how others will be affected by my words and actions. Rarely	Almost neverI consider how others will be affected by my words and actions. Almost never
When I get an assignment, I start right away and keep working until it is complete.	Most of the timeWhen I get an assignment, I start right away and keep working until it is complete. Most of the time	OftenWhen I get an assignment, I start right away and keep working until it is complete. Often	SometimesWhen I get an assignment, I start right away and keep working until it is complete. Sometimes	RarelyWhen I get an assignment, I start right away and keep working until it is complete. Rarely	Almost neverWhen I get an assignment, I start right away and keep working until it is complete. Almost never
I find it difficult to keep my mind on a task.	Most of the timeI find it difficult to keep my mind on a task. Most of the time	OftenI find it difficult to keep my mind on a task. Often	SometimesI find it difficult to keep my mind on a task. Sometimes	RarelyI find it difficult to keep my mind on a task. Rarely	Almost neverI find it difficult to keep my mind on a task. Almost never

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Please indicate how much you agree with the following statements *

	Strongly agree	Agree	Somewhat agree or disagree	Disagree	Strongly disagree
Unless I needed another professional opinion on a patient, I would not explicitly discuss his or her ailments or issues with other members of the staff.	Strongly agreeUnless I needed another professional opinion on a patient, I would not explicitly discuss his or her ailments or issues with other members of the staff. Strongly agree	AgreeUnless I needed another professional opinion on a patient, I would not explicitly discuss his or her ailments or issues with other members of the staff. Agree	Somewhat agree or disagreeUnless I needed another professional opinion on a patient, I would not explicitly discuss his or her ailments or issues with other members of the staff. Somewhat agree or disagree	DisagreeUnless I needed another professional opinion on a patient, I would not explicitly discuss his or her ailments or issues with other members of the staff. Disagree	Strongly disagreeUnless I needed another professional opinion on a patient, I would not explicitly discuss his or her ailments or issues with other members of the staff. Strongly disagree
I find it's better not to get my hopes up, so that I don't end up disappointed.	Strongly agreeI find it's better not to get my hopes up, so that I don't end up disappointed. Strongly agree	AgreeI find it's better not to get my hopes up, so that I don't end up disappointed. Agree	Somewhat agree or disagreeI find it's better not to get my hopes up, so that I don't end up disappointed. Somewhat agree or disagree	DisagreeI find it's better not to get my hopes up, so that I don't end up disappointed. Disagree	Strongly disagreeI find it's better not to get my hopes up, so that I don't end up disappointed. Strongly disagree
I would be at ease making everyday decisions for a patient if he/she was incapable of doing so due to illness.	Strongly agreeI would be at ease making everyday decisions for a patient if he/she was incapable of doing so due to illness. Strongly agree	AgreeI would be at ease making everyday decisions for a patient if he/she was incapable of doing so due to illness. Agree	Somewhat agree or disagreeI would be at ease making everyday decisions for a patient if he/she was incapable of doing so due to illness. Somewhat agree or disagree	DisagreeI would be at ease making everyday decisions for a patient if he/she was incapable of doing so due to illness. Disagree	Strongly disagreeI would be at ease making everyday decisions for a patient if he/she was incapable of doing so due to illness. Strongly disagree
No matter what life throws at me, I believe I can deal with it.	Strongly agreeNo matter what life throws at me, I believe I can deal with it. Strongly agree	AgreeNo matter what life throws at me, I believe I can deal with it. Agree	Somewhat agree or disagreeNo matter what life throws at me, I believe I can deal with it. Somewhat agree or disagree	DisagreeNo matter what life throws at me, I believe I can deal with it. Disagree	Strongly disagreeNo matter what life throws at me, I believe I can deal with it. Strongly disagree
I take pride in my work.	Strongly agreeI take pride in my work. Strongly agree	AgreeI take pride in my work. Agree	Somewhat agree or disagreeI take pride in my work. Somewhat agree or disagree	DisagreeI take pride in my work. Disagree	Strongly disagreeI take pride in my work. Strongly disagree
I think that it's important to maintain a sense of humor when life gets particularly rough.	Strongly agreeI think that it's important to maintain a sense of humor when life gets particularly rough. Strongly agree	AgreeI think that it's important to maintain a sense of humor when life gets particularly rough. Agree	Somewhat agree or disagreeI think that it's important to maintain a sense of humor when life gets particularly rough. Somewhat agree or disagree	DisagreeI think that it's important to maintain a sense of humor when life gets particularly rough. Disagree	Strongly disagreeI think that it's important to maintain a sense of humor when life gets particularly rough. Strongly disagree
A complete job means having accounted for every detail within my control.	Strongly agreeA complete job means having accounted for every detail within my control. Strongly agree	AgreeA complete job means having accounted for every detail within my control. Agree	Somewhat agree or disagreeA complete job means having accounted for every detail within my control. Somewhat agree or disagree	DisagreeA complete job means having accounted for every detail within my control. Disagree	Strongly disagreeA complete job means having accounted for every detail within my control. Strongly disagree
People get hurt on the job because they don't follow safety rules closely enough.	Strongly agreePeople get hurt on the job because they don't follow safety rules closely enough. Strongly agree	AgreePeople get hurt on the job because they don't follow safety rules closely enough. Agree	Somewhat agree or disagreePeople get hurt on the job because they don't follow safety rules closely enough. Somewhat agree or disagree	DisagreePeople get hurt on the job because they don't follow safety rules closely enough. Disagree	Strongly disagreePeople get hurt on the job because they don't follow safety rules closely enough. Strongly disagree
I believe that revealing even the smallest detail about a patient with people who are not involved would be a huge breach of trust.	Strongly agreeI believe that revealing even the smallest detail about a patient with people who are not involved would be a huge breach of trust. Strongly agree	AgreeI believe that revealing even the smallest detail about a patient with people who are not involved would be a huge breach of trust. Agree	Somewhat agree or disagreeI believe that revealing even the smallest detail about a patient with people who are not involved would be a huge breach of trust. Somewhat agree or disagree	DisagreeI believe that revealing even the smallest detail about a patient with people who are not involved would be a huge breach of trust. Disagree	Strongly disagreeI believe that revealing even the smallest detail about a patient with people who are not involved would be a huge breach of trust. Strongly disagree

Please indicate whether the following statements are true or false about you. *

	Strongly agree	Agree	Somewhat agree or disagree	Disagree	Strongly disagree
Unless I have my patient's consent, I would not share his/her medical information with anyone.	Strongly agreeUnless I have my patient's consent, I would not share his/her medical information with anyone. Strongly agree	AgreeUnless I have my patient's consent, I would not share his/her medical information with anyone. Agree	Somewhat agree or disagreeUnless I have my patient's consent, I would not share his/her medical information with anyone. Somewhat agree or disagree	DisagreeUnless I have my patient's consent, I would not share his/her medical information with anyone. Disagree	Strongly disagreeUnless I have my patient's consent, I would not share his/her medical information with anyone. Strongly disagree
I would be able to be firm with patient if a situation required (e.g. if he/she refused to take his/her medication).	Strongly agreeI would be able to be firm with patient if a situation required (e.g. if he/she refused to take his/her medication). Strongly agree	AgreeI would be able to be firm with patient if a situation required (e.g. if he/she refused to take his/her medication). Agree	Somewhat agree or disagreeI would be able to be firm with patient if a situation required (e.g. if he/she refused to take his/her medication). Somewhat agree or disagree	DisagreeI would be able to be firm with patient if a situation required (e.g. if he/she refused to take his/her medication). Disagree	Strongly disagreeI would be able to be firm with patient if a situation required (e.g. if he/she refused to take his/her medication). Strongly disagree
I strive to get along and cooperate with other people involved in a patient's care.	Strongly agreeI strive to get along and cooperate with other people involved in a patient's care. Strongly agree	AgreeI strive to get along and cooperate with other people involved in a patient's care. Agree	Somewhat agree or disagreeI strive to get along and cooperate with other people involved in a patient's care. Somewhat agree or disagree	DisagreeI strive to get along and cooperate with other people involved in a patient's care. Disagree	Strongly disagreeI strive to get along and cooperate with other people involved in a patient's care. Strongly disagree
I have a knack for tasks that require absolute precision.	Strongly agreeI have a knack for tasks that require absolute precision. Strongly agree	AgreeI have a knack for tasks that require absolute precision. Agree	Somewhat agree or disagreeI have a knack for tasks that require absolute precision. Somewhat agree or disagree	DisagreeI have a knack for tasks that require absolute precision. Disagree	Strongly disagreeI have a knack for tasks that require absolute precision. Strongly disagree
I don't mind following strict procedures and guidelines if it means that my workplace will be safer.	Strongly agreeI don't mind following strict procedures and guidelines if it means that my workplace will be safer. Strongly agree	AgreeI don't mind following strict procedures and guidelines if it means that my workplace will be safer. Agree	Somewhat agree or disagreeI don't mind following strict procedures and guidelines if it means that my workplace will be safer. Somewhat agree or disagree	DisagreeI don't mind following strict procedures and guidelines if it means that my workplace will be safer. Disagree	Strongly disagreeI don't mind following strict procedures and guidelines if it means that my workplace will be safer. Strongly disagree
I trust my intuition.	Strongly agreeI trust my intuition. Strongly agree	AgreeI trust my intuition. Agree	Somewhat agree or disagreeI trust my intuition. Somewhat agree or disagree	DisagreeI trust my intuition. Disagree	Strongly disagreeI trust my intuition. Strongly disagree
I do tasks carefully even if no one else will ever see the result.	Strongly agreeI do tasks carefully even if no one else will ever see the result. Strongly agree	AgreeI do tasks carefully even if no one else will ever see the result. Agree	Somewhat agree or disagreeI do tasks carefully even if no one else will ever see the result. Somewhat agree or disagree	DisagreeI do tasks carefully even if no one else will ever see the result. Disagree	Strongly disagreeI do tasks carefully even if no one else will ever see the result. Strongly disagree
People know that they can count on me.	Strongly agreePeople know that they can count on me. Strongly agree	AgreePeople know that they can count on me. Agree	Somewhat agree or disagreePeople know that they can count on me. Somewhat agree or disagree	DisagreePeople know that they can count on me. Disagree	Strongly disagreePeople know that they can count on me. Strongly disagree
My work suffers when I have problems in my personal life.	Strongly agreeMy work suffers when I have problems in my personal life. Strongly agree	AgreeMy work suffers when I have problems in my personal life. Agree	Somewhat agree or disagreeMy work suffers when I have problems in my personal life. Somewhat agree or disagree	DisagreeMy work suffers when I have problems in my personal life. Disagree	Strongly disagreeMy work suffers when I have problems in my personal life. Strongly disagree
I would talk about my patients with friends and/or family members, even if I'm not really supposed to share any private information.	Strongly agreeI would talk about my patients with friends and/or family members, even if I'm not really supposed to share any private information. Strongly agree	AgreeI would talk about my patients with friends and/or family members, even if I'm not really supposed to share any private information. Agree	Somewhat agree or disagreeI would talk about my patients with friends and/or family members, even if I'm not really supposed to share any private information. Somewhat agree or disagree	DisagreeI would talk about my patients with friends and/or family members, even if I'm not really supposed to share any private information. Disagree	Strongly disagreeI would talk about my patients with friends and/or family members, even if I'm not really supposed to share any private information. Strongly disagree

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How well do the following statements describe you? *

	Exactly like me	A lot like me	Somewhat like me	A little like me	Not at all like me
When I am feeling down, I remind myself to focus on the good things in my life instead of the bad.	Exactly like meWhen I am feeling down, I remind myself to focus on the good things in my life instead of the bad. Exactly like me	A lot like meWhen I am feeling down, I remind myself to focus on the good things in my life instead of the bad. A lot like me	Somewhat like meWhen I am feeling down, I remind myself to focus on the good things in my life instead of the bad. Somewhat like me	A little like meWhen I am feeling down, I remind myself to focus on the good things in my life instead of the bad. A little like me	Not at all like meWhen I am feeling down, I remind myself to focus on the good things in my life instead of the bad. Not at all like me
I get frustrated when someone can't keep up with me.	Exactly like meI get frustrated when someone can't keep up with me. Exactly like me	A lot like meI get frustrated when someone can't keep up with me. A lot like me	Somewhat like meI get frustrated when someone can't keep up with me. Somewhat like me	A little like meI get frustrated when someone can't keep up with me. A little like me	Not at all like meI get frustrated when someone can't keep up with me. Not at all like me
I make myself available to others when they need help.	Exactly like meI make myself available to others when they need help. Exactly like me	A lot like meI make myself available to others when they need help. A lot like me	Somewhat like meI make myself available to others when they need help. Somewhat like me	A little like meI make myself available to others when they need help. A little like me	Not at all like meI make myself available to others when they need help. Not at all like me
In general, once I've reached a decision, I feel good about it.	Exactly like meIn general, once I've reached a decision, I feel good about it. Exactly like me	A lot like meIn general, once I've reached a decision, I feel good about it. A lot like me	Somewhat like meIn general, once I've reached a decision, I feel good about it. Somewhat like me	A little like meIn general, once I've reached a decision, I feel good about it. A little like me	Not at all like meIn general, once I've reached a decision, I feel good about it. Not at all like me
I am deeply concerned for the welfare of others.	Exactly like meI am deeply concerned for the welfare of others. Exactly like me	A lot like meI am deeply concerned for the welfare of others. A lot like me	Somewhat like meI am deeply concerned for the welfare of others. Somewhat like me	A little like meI am deeply concerned for the welfare of others. A little like me	Not at all like meI am deeply concerned for the welfare of others. Not at all like me
I need others to reassure me that I have made a good decision.	Exactly like meI need others to reassure me that I have made a good decision. Exactly like me	A lot like meI need others to reassure me that I have made a good decision. A lot like me	Somewhat like meI need others to reassure me that I have made a good decision. Somewhat like me	A little like meI need others to reassure me that I have made a good decision. A little like me	Not at all like meI need others to reassure me that I have made a good decision. Not at all like me
I have a regular fitness routine (i.e., tennis, walking, weight training).	Exactly like meI have a regular fitness routine (i.e., tennis, walking, weight training). Exactly like me	A lot like meI have a regular fitness routine (i.e., tennis, walking, weight training). A lot like me	Somewhat like meI have a regular fitness routine (i.e., tennis, walking, weight training). Somewhat like me	A little like meI have a regular fitness routine (i.e., tennis, walking, weight training). A little like me	Not at all like meI have a regular fitness routine (i.e., tennis, walking, weight training). Not at all like me
I am uncomfortable making decisions.	Exactly like meI am uncomfortable making decisions. Exactly like me	A lot like meI am uncomfortable making decisions. A lot like me	Somewhat like meI am uncomfortable making decisions. Somewhat like me	A little like meI am uncomfortable making decisions. A little like me	Not at all like meI am uncomfortable making decisions. Not at all like me
I purposefully avoid or eliminate obstacles that could prevent me from completing a task or reaching my goal.	Exactly like meI purposefully avoid or eliminate obstacles that could prevent me from completing a task or reaching my goal. Exactly like me	A lot like meI purposefully avoid or eliminate obstacles that could prevent me from completing a task or reaching my goal. A lot like me	Somewhat like meI purposefully avoid or eliminate obstacles that could prevent me from completing a task or reaching my goal. Somewhat like me	A little like meI purposefully avoid or eliminate obstacles that could prevent me from completing a task or reaching my goal. A little like me	Not at all like meI purposefully avoid or eliminate obstacles that could prevent me from completing a task or reaching my goal. Not at all like me
I am a very patient person.	Exactly like meI am a very patient person. Exactly like me	A lot like meI am a very patient person. A lot like me	Somewhat like meI am a very patient person. Somewhat like me	A little like meI am a very patient person. A little like me	Not at all like meI am a very patient person. Not at all like me
I am easily discouraged.	Exactly like meI am easily discouraged. Exactly like me	A lot like meI am easily discouraged. A lot like me	Somewhat like meI am easily discouraged. Somewhat like me	A little like meI am easily discouraged. A little like me	Not at all like meI am easily discouraged. Not at all like me
I am meticulous.	Exactly like meI am meticulous. Exactly like me	A lot like meI am meticulous. A lot like me	Somewhat like meI am meticulous. Somewhat like me	A little like meI am meticulous. A little like me	Not at all like meI am meticulous. Not at all like me
I am easily distracted.	Exactly like meI am easily distracted. Exactly like me	A lot like meI am easily distracted. A lot like me	Somewhat like meI am easily distracted. Somewhat like me	A little like meI am easily distracted. A little like me	Not at all like meI am easily distracted. Not at all like me
When a small thing goes wrong, I feel like the world is ending.	Exactly like meWhen a small thing goes wrong, I feel like the world is ending. Exactly like me	A lot like meWhen a small thing goes wrong, I feel like the world is ending. A lot like me	Somewhat like meWhen a small thing goes wrong, I feel like the world is ending. Somewhat like me	A little like meWhen a small thing goes wrong, I feel like the world is ending. A little like me	Not at all like meWhen a small thing goes wrong, I feel like the world is ending. Not at all like me
My moods change quickly.	Exactly like meMy moods change quickly. Exactly like me	A lot like meMy moods change quickly. A lot like me	Somewhat like meMy moods change quickly. Somewhat like me	A little like meMy moods change quickly. A little like me	Not at all like meMy moods change quickly. Not at all like me
Stress motivates me to work harder.	Exactly like meStress motivates me to work harder. Exactly like me	A lot like meStress motivates me to work harder. A lot like me	Somewhat like meStress motivates me to work harder. Somewhat like me	A little like meStress motivates me to work harder. A little like me	Not at all like meStress motivates me to work harder. Not at all like me
I can work well despite fatigue.	Exactly like meI can work well despite fatigue. Exactly like me	A lot like meI can work well despite fatigue. A lot like me	Somewhat like meI can work well despite fatigue. Somewhat like me	A little like meI can work well despite fatigue. A little like me	Not at all like meI can work well despite fatigue. Not at all like me
I perform well under pressure.	Exactly like meI perform well under pressure. Exactly like me	A lot like meI perform well under pressure. A lot like me	Somewhat like meI perform well under pressure. Somewhat like me	A little like meI perform well under pressure. A little like me	Not at all like meI perform well under pressure. Not at all like me
I have an uncanny ability to guess how others are feeling.	Exactly like meI have an uncanny ability to guess how others are feeling. Exactly like me	A lot like meI have an uncanny ability to guess how others are feeling. A lot like me	Somewhat like meI have an uncanny ability to guess how others are feeling. Somewhat like me	A little like meI have an uncanny ability to guess how others are feeling. A little like me	Not at all like meI have an uncanny ability to guess how others are feeling. Not at all like me
	Exactly like meExactly like me	A lot like meA lot like me	Somewhat like meSomewhat like me	A little like meA little like me	Not at all like meNot at all like me

How often do you do the following actions? *

	Quite often	Often	Sometimes	Rarely	Almost never
I make "to do" lists.	Quite oftenI make "to do" lists. Quite often	OftenI make "to do" lists. Often	SometimesI make "to do" lists. Sometimes	RarelyI make "to do" lists. Rarely	Almost neverI make "to do" lists. Almost never
I lose my temper.	Quite oftenI lose my temper. Quite often	OftenI lose my temper. Often	SometimesI lose my temper. Sometimes	RarelyI lose my temper. Rarely	Almost neverI lose my temper. Almost never
I lose important things/documents.	Quite oftenI lose important things/documents. Quite often	OftenI lose important things/documents. Often	SometimesI lose important things/documents. Sometimes	RarelyI lose important things/documents. Rarely	Almost neverI lose important things/documents. Almost never
I procrastinate.	Quite oftenI procrastinate. Quite often	OftenI procrastinate. Often	SometimesI procrastinate. Sometimes	RarelyI procrastinate. Rarely	Almost neverI procrastinate. Almost never
I develop templates, shortcuts, or standard procedures for my routine tasks.	Quite oftenI develop templates, shortcuts, or standard procedures for my routine tasks. Quite often	OftenI develop templates, shortcuts, or standard procedures for my routine tasks. Often	SometimesI develop templates, shortcuts, or standard procedures for my routine tasks. Sometimes	RarelyI develop templates, shortcuts, or standard procedures for my routine tasks. Rarely	Almost neverI develop templates, shortcuts, or standard procedures for my routine tasks. Almost never
People call me a blabbermouth.	Quite oftenPeople call me a blabbermouth. Quite often	OftenPeople call me a blabbermouth. Often	SometimesPeople call me a blabbermouth. Sometimes	RarelyPeople call me a blabbermouth. Rarely	Almost neverPeople call me a blabbermouth. Almost never
I notice typos and other errors in documents and publications.	Quite oftenI notice typos and other errors in documents and publications. Quite often	OftenI notice typos and other errors in documents and publications. Often	SometimesI notice typos and other errors in documents and publications. Sometimes	RarelyI notice typos and other errors in documents and publications. Rarely	Almost neverI notice typos and other errors in documents and publications. Almost never
I tend to overreact to minor annoyances.	Quite oftenI tend to overreact to minor annoyances. Quite often	OftenI tend to overreact to minor annoyances. Often	SometimesI tend to overreact to minor annoyances. Sometimes	RarelyI tend to overreact to minor annoyances. Rarely	Almost neverI tend to overreact to minor annoyances. Almost never
People compliment my efficiency.	Quite oftenPeople compliment my efficiency. Quite often	OftenPeople compliment my efficiency. Often	SometimesPeople compliment my efficiency. Sometimes	RarelyPeople compliment my efficiency. Rarely	Almost neverPeople compliment my efficiency. Almost never
I exceed expectations.	Quite oftenI exceed expectations. Quite often	OftenI exceed expectations. Often	SometimesI exceed expectations. Sometimes	RarelyI exceed expectations. Rarely	Almost neverI exceed expectations. Almost never

Save and Resume Later

When working in a team, I am: *

Very flexible and always try to alter ineffective habits.
Flexible and generally try to alter ineffective habits.
Somewhat flexible and will occasionally alter my habits.
Generally disinclined to alter my behavior.
Averse to the idea of altering my behavior.

In comparison to others, I accomplish tasks: *

Much more quickly.
More quickly.
At the same rate.
More slowly.
Much more slowly.

If a co-worker started to get on my nerves, I would most likely respond in the following way: *

I would tell him/her right away that s/he is getting on my nerves because of X personality trait that I don't like, and that s/he should leave me alone.
I would hold it in as long as possible and then finally snap, telling him/her to get out of my face.
I would explain that I am feeling overwhelmed with work/school/life and need a break from social obligations to be by myself for a while.
I would explain what is bothering me, and ask for some time to myself.

I am _____ energetic than most people. *

Much more
More
Neither more nor less
Less
Much less

My friends would say I am: *

Completely dependable
Very dependable
Somewhat dependable/undependable
Very undependable
Completely undependable

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I am comfortable telling members of a team what I need from them. *

Of course!
Yes, provided my team members aren't defensive about it.
I generally do not like it.
I tend not to be aware enough to know what needs to be done.

If a friend or co-worker seems grumpy, *

I assume that there is a reason for his/her grumpiness.
I ask what is bothering him/her.
I assume that s/he is being unpleasant for no reason.
I get annoyed and become grumpy myself.

If I feel strongly about the way to handle a difficult case (e.g. how to treat a specific patient's illness) but my colleagues disagree, I: *

get frustrated and insist that my idea be implemented.
can't help but stress my idea's good points even if my colleauges prefer to think of an alternative treatment.
highlight the reasons I feel my idea is good in an attempt to convince them.
ask that we look over the pros and cons of my idea one last time so as to be sure my point of view has been given a fair chance.
review the cons that were brought up during the discussion so as to be persuaded myself and not hinder our work.

If someone who is usually even-tempered snaps at me, I: *

Assume that s/he is probably having a bad day.
May be hurt initially, but I often come to the realization that s/he is probably having a bad day.
Get defensive and snap back.
Reconsider my opinion about that person.

When is it appropriate to leave work early without permission? *

When your boss is out of the office and you have finished up your work for the day.
When you don't get paid enough to make it worthwhile for you to stay.
When you are planning to make up the time later.
In family or personal emergencies, including illness.
It is inappropriate to leave early without permission in all of the above situations.
It is appropriate to leave early without permission in all of the above situations.

How hard would it be for you to accept new rules in a routine, e.g., having to check with a supervisor before beginning a task or having to do a safety check several times a day? *

Extremely
Very
Somewhat
A bit
Not at all

Your boss yells at your co-worker in front of the entire office. Your co-worker most likely feels primarily: *

Ashamed
Inspired
Furious
Worried
Sad
I don't know

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In the upcoming questions, you will be given various real world scenarios. Please respond to these examples with how your feel or would respond.

Amelia is struggling with her job - she's been unhappy for a quite some time. She considered quitting, but her salary is great compared to most other jobs and she is worried about finding work in an uncertain economy. She's feeling extremely depressed about her situation. Which of the following strategies has the best chance of helping Amelia overcome her job dissatisfaction? *

Talking with her boss to find a way to make her current job more tolerable.
Quitting her job before finding another one.
Quitting her job as soon as she finds another one.
Doing nothing and hoping for the best.
Deliberately sabotaging herself at work (working inefficiently or being careless) until she is forced to leave.
I don't know

Sandra is involved in an interesting case at the hospital where she works. Coincidentally, she is participating in a seminar that covers a similar topic. She feels her experience with this particular patient would be a perfect addition to the issues that will be discussed at the session. It is unlikely that any of the other participants will know the patient. Imagine you are in Sandra's shoes and indicate which piece of information you would be comfortable sharing in the seminar if all personally identifiable information was removed. *

I would not share anything about the case during the seminar.
General info about the diagnosis in this particular case.
Details about the patient that are strictly relevant to the topic.
Length of the patient's stay in the hospital.
Discussion of the patient's diagnosis or treatment.
Reactions of patient's family to the diagnosis.
Recounts of discussions with the patient.
Details about the patient that are not directly relevant to the topic but that spice up the discussion.

Harry has been experiencing insomnia for several weeks and it is taking a toll on his mental and physical health. He's beginning to feel anxious and worried about being able to fall asleep before he even goes to bed. What should Harry do to fix his problem for the long-term? *

Get some over-the-counter sleep pills, stat!
Keep trying to sleep without changing his routine, and hope for the best
Have a drink or two every night to encourage sleep
Consult a physician and take it from there
Look at ways to reduce his anxiety, such as meditation and yoga
I don't know.

Trina is waiting patiently for a late doctor's appointment when someone who came in much later than her gets to see the doctor. She most likely feels primarily: *

Annoyed
Indifferent
Suspicious
Jealous
Calm
I don't know

Tim recently found out that his co-workers at the music store he works at make much more money than him. He was angry at this realization, especially since he hardly makes enough money to get by, but he knows that his manager won't listen to reason and that he just has to live with the situation. When his boss was away one afternoon, he decided to try to "level the playing field" by bringing home a couple of CDs he didn't pay for to give as Christmas presents. He would never have been able to afford the presents he wants to give at his salary! Was he wrong to take the CDs? *

He wasn't wrong per se, but he definitely wasn't right.
No, he has to make up for his poor salary somehow.
Yes, his situation may be bad, but he was wrong to take those things.

Jill works in a clothing store. She has been working there several years without promotion or any substantial pay raise. She knows she brings in lots of money for her employer and feels that she deserves to make a better salary. One day she notices that the cash register has more money in it than the receipts for the day suggest. What should she do? *

She should take the extra money to buy something for herself. She deserves it after all that hard work!
She should take the extra money and give it to someone who really needs it.
She should wait to see if anyone else notices, and if they don't, she should keep it.
She should tell her supervisor about the money.

Should she be punished if she decides to take the money and gets caught? *

She should be arrested.
She should have to make up the money from her paychecks.
She should be given a formal warning that goes on her record.
She should get a warning, but nothing that will go into her permanent record.
She shouldn't be punished - many people would do the same thing in her position.

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Please read the following scenarios and indicate which of the following responses is most similar to your feelings.

Bob and Betsy are debating whether using a sick day for reasons other than illness is wrong.

Bob: The other day the weather was so nice; I couldn't stand the thought of going to work. I didn't think I could handle another minute of the daily grind without some kind of break. So I called in sick.
Betsy: Really? Personally, I don't think it's right. Your boss should be able to count on you - you should be at work unless you are too sick to come in.
Bob: I get five sick days a year, and I rarely use them. It makes no difference for my employer whether I'm really sick or just need to slow down!

I agree almost entirely with Bob.
I agree with Bob, but I think Betsy makes some good points.
I agree equally with Bob and Betsy.
I agree with Betsy, but I think Bob makes some good points.
I agree almost entirely with Betsy.

Sam and Bill are discussing the dismissal of a co-worker.
Sam: Last Friday, Andy from accounting got fired for taking a printer cartridge for his printer at home.
Bill: Really? I hardly blame him. He hasn't had a raise in more than five years, and his boss is such a jerk.
Sam: Maybe so, but taking anything, no matter how small, from your employer isn't right.

(copy) *

I agree almost entirely with Sam.
I agree with Sam, but I think Bill makes some good points.
I agree equally with Sam and Bill.
I agree with Bill, but I think Sam makes some good points.
I agree almost entirely with Bill.

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