| 1. Team's purpose | 
| ----- | I'm uncertain----- | 1 | 2 | 3 | 4 | 5 | ----- | I'm clear | 
| 2. Team membership | 
| ----- | I'm out----- | 1 | 2 | 3 | 4 | 5 | ----- | I'm in | 
| 3. Communications | 
| ----- | Very guarded----- | 1 | 2 | 3 | 4 | 5 | ----- | Very open | 
| 4. Team goals | 
| ----- | Set from above----- | 1 | 2 | 3 | 4 | 5 | ----- | Emerged through team interaction | 
| 5. Use of team member's skills | 
| ----- | Poor use----- | 1 | 2 | 3 | 4 | 5 | ----- | Good use | 
| 6. Support | 
| ----- | Little help for individuals----- | 1 | 2 | 3 | 4 | 5 | ----- | High level of support for individuals | 
| 7. Conflict | 
| ----- | Difficult issues are avoided----- | 1 | 2 | 3 | 4 | 5 | ----- | Problems are discussed openly and directly | 
| 8. Influence on decisions | 
| ----- | By few members----- | 1 | 2 | 3 | 4 | 5 | ----- | By all members | 
| 9. Risk taking | 
| ----- | Not encouraged----- | 1 | 2 | 3 | 4 | 5 | ----- | Encouraged and supported | 
| 10. Working on relationships with
others | 
| ----- | Little effort----- | 1 | 2 | 3 | 4 | 5 | ----- | High level of effort | 
| 11. Distribution of leadership | 
| ----- | Limited----- | 1 | 2 | 3 | 4 | 5 | ----- | Shared | 
| 12. Useful feedback | 
| ----- | Very little----- | 1 | 2 | 3 | 4 | 5 | ----- | Considerable |