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Human Resources

Diversity & Inclusion Survey

An anonymous read on belonging, fairness, and whether every voice gets heard.

4 questions · 1 page · about 2 minutes to answer · fully editable after you start

Inclusion is measured in small moments: whether people feel safe speaking up, whether credit lands fairly, whether meetings have room for every voice. This survey asks about those moments directly, on an agreement scale, with an explicit anonymous-mode recommendation – belonging data is only honest when it cannot be traced.

Report results at the company level and by department only where groups are large enough to protect anonymity. The write-in question consistently surfaces the specific behaviours and blind spots that scale questions cannot name.

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This is a picture of every question as a respondent would see it, so nothing on it can be clicked or typed into. Use this template to get your own editable copy.

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Page 1

Belonging here

This survey asks about your experience of inclusion at work. Your answers help us see where we are doing well and where we need to change. It takes about 2 minutes.

Q1.How much do you agree with each statement?*

DisagreeSomewhat disagreeSomewhat agreeAgree
I feel I belong on my team
I can voice a contrary opinion without fear
Credit for work is given fairly
Leadership genuinely cares about inclusion
People of all backgrounds can succeed here

Q2.How included do you feel day to day?*

12345678910
ExcludedFully included

Q3.Have you seen or experienced something we should know about? (Optional, anonymous.)

Respondent types their answer here…

Q4.What one action would make this a more inclusive place?

Respondent types their answer here…

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