Assertiveness Assessment Form Welcome to your Assertiveness Assessment Form Name Age Email Q.1: When talking to people, do you look them in the eye? Yes No None Q.2: Do you project your voice as you speak? Are you clear and loud enough to be heard? Yes No None Q.3: Are you confident? Or are your sentences filled with gaps, “ums,” and “errs”? Yes No None Q.4: How are standing or seated when dealing with others? Are you upright or looking downward? Yes No None Q.5: Are you able to ask the questions you have, or do you shy away from them? Yes No None Q.6: Are you comfortable around others? Yes No None Q.7: Do you feel able to say “no” when asked things? Yes No None Q.8: Can you show when you are annoyed, if appropriate? Yes No None Q.9: Can you disagree with what is being said when you have an alternative opinion or different beliefs? Yes No None Q.10: Are you able to defend yourself when you are being blamed for something that wasn’t your fault? Yes No None Time's up
