Diversity and Inclusion Survey Template

1. What is your gender?

The answer should be a single choice:

1. Male
2. Female
3. Prefer not to say
4. Other

2. What is your age range?

The answer should be a single choice:

1. 18-24
2. 25-34
3. 35-44
4. 45-54
5. 55-64
6. 65+
7. Prefer not to say

3. What is your race or ethnicity?

The answer should be a single choice:

White

1. British
2. Irish
3. Other

Asian or Asian British

4. Indian
5. Pakistani
6. Bangladeshi
7. Any other Asian background

Mixed

8. White and Black Caribbean
9. White and black African
10. White and Asian
11. Any other mixed background

Black or Black British

12. Caribbean
13. African
14. Any other black background

Other Ethnic Group

15. Chinese
16. Any other Ethnic Group
17. I do not wish to disclose my ethnic origin

4. How satisfied are you with the level of diversity in our workplace?

The answer should be a single choice:

1. Very dissatisfied
2. Dissatisfied
3. Neutral
4. Satisfied
5. Very satisfied

5. To what extent do you feel valued and included in the workplace?

The answer should be a single choice:

1. Not at all
2. Slightly
3. Moderately
4. Greatly
5. Completely

6. Have you personally experienced any incidents of discrimination or harassment in the workplace?

The answer should be a single choice:

1. Yes
2. No

7. Have you witnessed any incidents of discrimination or harassment in the workplace?

The answer should be a single choice:

1. Yes
2. No

8. In your opinion, what more can be done to promote diversity and inclusion in the workplace?

The answer should be a multi line text input.

9. Have you received any diversity and inclusion training at our company?

The answer should be a single choice:

1. Yes
2. No

10. How frequently would you like to receive diversity and inclusion training?

The answer should be a single choice:

1. Once a year
2. Twice a year
3. Three times a year
4. More often

11. What topics would you like to see covered in future diversity and inclusion training sessions?

The answer should be a multi line text input.