Please indicate the extent to which you either agree or disagree with the following statements in regards to
________________________.
As a member of my team, this individual:
Provided a good role model
1 ....................... 2 ....................... 3 ....................... 4 ....................... 5
Strongly
Disagree
Neither Agree
Agree
Strongly
Disagree
nor Disagree
Agree
Led by example
1 ....................... 2 ....................... 3 ....................... 4 ....................... 5
Strongly
Disagree
Neither Agree
Agree
Strongly
Disagree
nor Disagree
Agree
Had a positive influence on other team members
1 ....................... 2 ....................... 3 ....................... 4 ....................... 5
Strongly
Disagree
Neither Agree
Agree
Strongly
Disagree
nor Disagree
Agree
Motivated other team members to do good work
1 ....................... 2 ....................... 3 ....................... 4 ....................... 5
Strongly
Disagree
Neither Agree
Agree
Strongly
Disagree
nor Disagree
Agree
Inspired other team members
1 ....................... 2 ....................... 3 ....................... 4 ....................... 5
Strongly
Disagree
Neither Agree
Agree
Strongly
Disagree
nor Disagree
Agree
Was able to get others committed to the team objectives
1 ....................... 2 ....................... 3 ....................... 4 ....................... 5
Strongly
Disagree
Neither Agree
Agree
Strongly
Disagree
nor Disagree
Agree
Showed respect for the feelings of other members
1 ....................... 2 ....................... 3 ....................... 4 ....................... 5
Strongly
Disagree
Neither Agree
Agree
Strongly
Disagree
nor Disagree
Agree
Worked effectively in collaboration with other members
1 ....................... 2 ....................... 3 ....................... 4 ....................... 5
Strongly
Disagree
Neither Agree
Agree
Strongly
Disagree
nor Disagree
Agree
Facilitated group interaction and work sharing
1 ....................... 2 ....................... 3 ....................... 4 ....................... 5
Strongly
Disagree
Neither Agree
Agree
Strongly
Disagree
nor Disagree
Agree