0 : Not at all
1
2
3
4
5 : Always
¹
0
1
2
3
4
5
1
If stranded somewhere there is someone who would get me.
2
I help others when they are too busy to get everything done.
3
People confide in me when they have problems.
4
I am a person others turn to for help with tasks.
5
I give others a sense of comfort in times of need.
6
There is someone in my life I can get emotional support from.
7
People close to me tell me their fears and worries.
8
I have helped someone with their responsibilities when they were unable to fulfil them..
9
When I am feeling down there is someone I can lean on.
10
There is at least one person that I can share most things with.
11
I have someone to help me if I am physically unwell.
12
There is someone who can help me fulfil my responsibilities when I am unable
The presented answer sheet is not an original form and is not intended for printing or use as a handout.
The answer numbers are used only to label response columns. They are NOT scores and should not be used for calculating results.