| 5 | 4 | 3 | 2 | 1 |
| At times I've excused myself without seeking to redress a grievance. | | | | | | |
| I am sometimes able to recognize my error where and when it occurs and make amends for it there and then. | | | | | | |
| I know that my life is mine to make, yet much seems beyond my control. | | | | | | |
| I may be ignorant of the wrongs I've done. | | | | | | |
| I persist in doing the same little error. | | | | | | |
| I told the person I wronged what it was that I did. | | | | | | |
| I've been insincere in my responses to others. | | | | | | |
| I've done the wrong thing, by my own choosing. | | | | | | |
| I've done things to others that I would not want done to myself. | | | | | | |
| I've done wrong under duress. | | | | | | |
| I've expressed sorrow for my actions, but only when I felt it might prevent worse consequences. | | | | | | |
| I've let friendships deteriorate because I haven't tried to bridge the gap of hurt. | | | | | | |
| I've not helped when I could. | | | | | | |
| I've said "I will" but then didn't. | | | | | | |
| I've said: "I won't" but then did. | | | | | | |
| I've thought of doing the right thing, but not acted on my thoughts. | | | | | | |
| I've thought: "Since I can't complete it, I won't bother to start." | | | | | | |
| Sometimes, even though I sincerely try to change my ways, I fall back into old patterns of behavior. | | | | | | |
| There's something I didn't do, and now I'm ashamed of it. | | | | | | |
| When I express sorrow for the wrongs I've committed, it is because of my awe and love of God. | | | | | | |
| When I share with others the fact that I've done wrong, I find that we all share the same experience and grow together. | | | | | | |
| Totals: | | | | | | |