This document contains a 21-item survey for evaluating team member effectiveness across 5 categories: contributing to the team's work, interacting with teammates, keeping the team on track, expecting quality, and having relevant knowledge, skills, and abilities. The respondent is asked to indicate their level of agreement with statements about their own contributions and behaviors. Their scores in each category are totaled and correspond to feedback about their level of effectiveness as a team member. An overall score of 84-105 points out of a possible 105 is described as demonstrating highly effective team membership.