FORM B

communication survey

Name : Date :

Gender : Male Female Title :

Organization :

Phone : Email :

SECTION 1 Scale (for both Parts)

1=Strongly Disagree 2= Somewhat Disagree 3=Neither Agree nor Disagree 4= Somewhat agree 5= Strongly Agree

Part A Instruction Part B Instruction

This is survey, there are no right or wrong answer. Circle the numbers Circle the numbers below wich best describe how you act when doing
below wich best describe how you feel you really are (when not under your job
outside pressure). Mark your responses quickly, as your first impression is
usually best.

1. Self-disciplined 1 2 3 4 5 26. Spirited 1 2 3 4 5 1. Reliable 1 2 3 4 5 26. Dominant 1 2 3 4 5

2. Daring 1 2 3 4 5 27. Steady 1 2 3 4 5 2. Intuitive 1 2 3 4 5 27. Traditional 1 2 3 4 5
3. Introverted 1 2 3 4 5 28. Creative 1 2 3 4 5 3. Serious 1 2 3 4 5 28. Assertive 1 2 3 4 5
4. Aggressive 1 2 3 4 5 29. Conforming 1 2 3 4 5 4. Passive 1 2 3 4 5 29. Fact-oriented 1 2 3 4 5
5. Analytical 1 2 3 4 5 30. Outgoing 1 2 3 4 5 5. Peaceful 1 2 3 4 5 30. Sympathetic 1 2 3 4 5

6. Perfectionistic 1 2 3 4 5 31. Abrupt 1 2 3 4 5 6. Timid 1 2 3 4 5 31. Strong 1 2 3 4 5

7. Enthusiastic 1 2 3 4 5 32. Upright 1 2 3 4 5 7. Nonconforming 1 2 3 4 5 32. Persevering 1 2 3 4 5
8. Demanding 1 2 3 4 5 33. Pleasant 1 2 3 4 5 8. Verbal 1 2 3 4 5 33. Enduring 1 2 3 4 5
9. Original 1 2 3 4 5 34. Visionary 1 2 3 4 5 9. Thorough 1 2 3 4 5 34. Striving 1 2 3 4 5

10. Detailed 1 2 3 4 5 35. Indecisive 1 2 3 4 5 10. Amiable 1 2 3 4 5 35. Expressive 1 2 3 4 5

11. Sociable 1 2 3 4 5 36. Self-assured 1 2 3 4 5 11. Planful 1 2 3 4 5 36. Accurate 1 2 3 4 5

12. Specific 1 2 3 4 5 37. Kind-hearted 1 2 3 4 5 12. Talkative 1 2 3 4 5 37. Impulsive 1 2 3 4 5
13. Stick-to-it 1 2 3 4 5 38. Organized 1 2 3 4 5 13. Gentle 1 2 3 4 5 38. Silent 1 2 3 4 5
14. Tolerant 1 2 3 4 5 39. Logical 1 2 3 4 5 14. Systematic 1 2 3 4 5 39. Patient 1 2 3 4 5
15. Responsible 1 2 3 4 5 40. Dependable 1 2 3 4 5 15. Competitive 1 2 3 4 5 40. Methodical 1 2 3 4 5

16. Compassionate 1 2 3 4 5 41. Precise 1 2 3 4 5 16. Conventional 1 2 3 4 5 41. Decisive 1 2 3 4 5

17. Careless 1 2 3 4 5 42. Powerful 1 2 3 4 5 17. Determined 1 2 3 4 5 42. Careful 1 2 3 4 5
18. Trustworthy 1 2 3 4 5 43. Conscientious 1 2 3 4 5 18. Communicative 1 2 3 4 5 43. Competent 1 2 3 4 5
19. Cooperative 1 2 3 4 5 44. Controlling 1 2 3 4 5 19. Prompt 1 2 3 4 5 44. Flexible 1 2 3 4 5

20. Thoughtful 1 2 3 4 5 45. Reserved 1 2 3 4 5 20. Rational 1 2 3 4 5 45. Social 1 2 3 4 5

21. Perceptive 1 2 3 4 5 46. Commanding 1 2 3 4 5 21. Imaginative 1 2 3 4 5 46. Easy-going 1 2 3 4 5

22. Cautions 1 2 3 4 5 47. Extroverted 1 2 3 4 5 22. Stable 1 2 3 4 5 47. Dutiful 1 2 3 4 5
23. Agreeable 1 2 3 4 5 48. Authoritative 1 2 3 4 5 23. Direct 1 2 3 4 5 48. Hard-driving 1 2 3 4 5
24. Shy 1 2 3 4 5 49. Understanding 1 2 3 4 5 24. Active 1 2 3 4 5 49. Bold 1 2 3 4 5
25. Reasoning 1 2 3 4 5 50. Efficient 1 2 3 4 5 25. Instinctive 1 2 3 4 5 50. Calm 1 2 3 4 5

Wisma 77, 16th floor. Jl. Jend. S. Parman Kav.77 jakarta 11410 Tel. (21) 5366 0111 Fax. (21) 5366 0222 email. [email protected]
v. 14/09/09
 communication survey

SECTION 2
I n st r u c ti o n : Please r ead each statem ent below. As s ign a True (T) or Fals e (F) res pons e to eac h statement.

T or F 1. I find it hard to imitate the behavior of other people

2. My behavior is usually an expression of my true inner feelings, attitudes, and beliefs..
3. At parties and social gatherings, I do not attempt to do nor say things that others will like.
4. I can only argue for ideas in which I already believe.
5. I can make impromptu speeches even on topics about which I have almost no information.
6. I guess I put on a show to impress or entertain others.
7. When I am uncertain of how to act in a social situation, I look to the behavior of others for cues
8. I would probably make a good actor.
9. I rarely seek the advice of my friends to choose movies, books, or music.
10. I sometimes appear to others to be experiencing deeper emotions than I actually am.
11. I laugh more when I watch a comedy with others than when I am alone.
12. In a group of people, I am rarely the center of attention.
13. In different situations and with different people, I often act like very different persons.
14. I am not particularly good at making other people like me.
15. Even if I am not enjoying myself, I often pretend to be having a good time.
16. I am not always the person I appear to be.
17. I would not change my opinions (or the way I do things) in order to please someone or win their favor.
18. I have considered being an entertainer.
19. In order to get along and be liked, I tend to be what people expect me to be rather than anything else.
20. I have never been good at games like charades or improvisational acting.
21. I have trouble changing my behavior to suit different people and different situations.
22. At a party, I let others keep the jokes and stories going.
23. I feel a bit awkward in company and do not show up as well as I should.
24. I can look anyone in the eye and tell a lie with a straight face (if for a right end).
25. I may deceive people by being friendly when I really dislike them.

SECTION 3
I n st r u c ti o n : Please answer these items carefully but do not spend too much time on any one item. Be sure to answer every item.
Also, try to respond to each item independently when making your choice, i.e. do not be influenced by your previous choices.

Please indicate your agreement or 1. I am constantly on the lookout for new ways to improve my life. 1 2 3 4 5 6 7
disagreement with each statement 2. I feel driven to make a difference in my community, and maybe the world. 1 2 3 4 5 6 7
below. Circle a number from 1 to 7 to 1 2 3 4 5 6 7
3. I tend to let others take the initiative to start new projects.
indicate that you :
4. Wherever I have been, I have been a powerful force for constructive change. 1 2 3 4 5 6 7
1 = Disagree strongly and completely
5. I enjoy facing and overcoming obstacles to my ideas. 1 2 3 4 5 6 7
2 = Disagree moderately
3 = Disagree slightly 6. Nothing is more exciting than seeing my ideas tum into reality. 1 2 3 4 5 6 7
4 = Neither agree nor disagree 7. If I see something that I do not like, I fix it. 1 2 3 4 5 6 7
5 = Agree slightly 8. No matter what the odds, if i believe in something, I will make it happen. 1 2 3 4 5 6 7
6 = Agree moderatly 9. I love being a champion for my ideas, even against others' opposition. 1 2 3 4 5 6 7
7 = Agree strongly and completely 10. I excel at identifying opportunities. 1 2 3 4 5 6 7

11. I am always looking for better ways to do things. 1 2 3 4 5 6 7

12. If I believe in an idea, no obstacle will prevent me from making It happen. 1 2 3 4 5 6 7
13. I love to challenge the status quo. 1 2 3 4 5 6 7
14 When I have a problem, I tackle it head-on. 1 2 3 4 5 6 7

15. I am great at turning problems into opportunities. 1 2 3 4 5 6 7

16. I can spot a good opportunity long before others can. 1 2 3 4 5 6 7

17. If I see someone in trouble, I help out in any way that I can. 1 2 3 4 5 6 7

Wisma 77, 16th floor. Jl. Jend. S. Parman Kav.77 jakarta 11410 Tel. (21) 5366 0111 Fax. (21) 5366 0222 email. [email protected]
v. 14/09/09