Organization Inclusiveness Survey

- Instructions -

  • This survey must be completed by a person expressing their own attitudes regarding Inclusiveness in your work environment.

  • A response must be given the Identifying Information, all 10 questions and the Demographic Information that follows the questions.

  • At the end of the form be sure to click the 'submit' button.




Identifying Information

For purposes of verifying your identity and collating your responses

please provide the following information about yourself:

First Name:
Last Name:
What is your Company?
What is your Employee e-mail address: 
Please enter your Employee ID (including leading zeros if any).  This ID will be used to identify you in order to provide feedback reports and analysis:

 

   

Very Strongly
Disagree

Strongly
Disagree

Disagree

Agree

Strongly
Agree

Very Strongly
Agree

1.
This organization supports the professional development of all employees.

2.
I feel that there are no barriers to my being promoted within the organization.

3.
I know where to find information on policies related to inclusiveness in my department.

4.
Management and supervisors are protective of loyal workers.

5.
I have witnessed acts of favoritism by management.

6.
I would quit this job if it were not for my commitment to the organization's goals.

7.
I have been treated fairly by my supervisor.

8.
I have been treated fairly by my fellow employees.

9.
Members of my unit treat me with an appropriate amount of respect.

10.
Managers treat employees with respect.



Please enter any comments which you feel are relevant to
Inclusiveness in your organization!



Demographic Information

 

What is your Age?


What is your Sex?   Male:   Female:


 
Caucasian
Bi-racial
Hispanic, Latino/a
African-American
Asian or
Pacific Islander
American Indian or Native Alaskan
Multi-racial
Other
 specify below
Which of the following categories best describes your race or ethnicity?


Other Race:







FORM SUBMISSION

Thank you for taking the time to answer the questions in the self-assessment.

By clicking the SUBMIT FORM button your responses will be submitted for analysis.

 

To erase this form and start over.   Press the Clear Form button.  

Please Note: This will Delete Everything you have entered on this page.

Thank you for completing this assessment!!!

 

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