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[SURVEY SAMPLE] REVIEW YOUR EMPLOYER – Best Companies for Diversity
Your anonymous review will help your employer understand what adjustments need to be made to support you at work. It’ll only take ten minutes!
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1. Which employer are you reviewing?
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2. Please choose the appropriate answer to indicate the extent to which you agree to the statements.
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Strongly Agree (SA)
Agree (A)
Neutral (N)
Disagree (DA)
Strongly Disagree (SDA)
1. I am proud to work at my company.
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2. I would recommend my company as a great place to work.
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3. I rarely think about looking for a job at another company.
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4. My job performance is evaluated fairly.
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5. I believe that my total compensation is fair, relative to similar roles in the company.
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6. When there are career opportunities at my company, I am aware of them.
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7. My company believes that people can always improve and grow.
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8. My job gives me the flexibility I need to take care of personal needs.
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9. Perspectives like mine are included in the decision-making at my company.
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10. I am included in decisions that affect my work.
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11. There is open and honest two-way communication between my manager and my team.
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12. I can voice a contrary opinion without fear of negative consequences.
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13. When I speak up, my opinion is valued.
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14. My company has forums available for me to ask questions and have my voice heard.
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15. I feel like I belong at my company.
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16. I feel respected at work.
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17. I can be my authentic self at work.
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18. I have at least one close friend at work.
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19. The diversity of the people I work with is important to me.
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20. My lead actively fosters an inclusive environment on my team.
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21. My company values diversity.
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22. My company is taking productive steps to improve inclusion and diversity.
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1. I am proud to work at my company.
2. I would recommend my company as a great place to work.
3. I rarely think about looking for a job at another company.
4. My job performance is evaluated fairly.
5. I believe that my total compensation is fair, relative to similar roles in the company.
6. When there are career opportunities at my company, I am aware of them.
7. My company believes that people can always improve and grow.
8. My job gives me the flexibility I need to take care of personal needs.
9. Perspectives like mine are included in the decision-making at my company.
10. I am included in decisions that affect my work.
11. There is open and honest two-way communication between my manager and my team.
12. I can voice a contrary opinion without fear of negative consequences.
13. When I speak up, my opinion is valued.
14. My company has forums available for me to ask questions and have my voice heard.
15. I feel like I belong at my company.
16. I feel respected at work.
17. I can be my authentic self at work.
18. I have at least one close friend at work.
19. The diversity of the people I work with is important to me.
20. My lead actively fosters an inclusive environment on my team.
21. My company values diversity.
22. My company is taking productive steps to improve inclusion and diversity.
Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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Agree (A)
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Neutral (N)
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Disagree (DA)
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Strongly Disagree (SDA)
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Strongly Agree (SA)
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3. What is one thing your company could do to create a more inclusive culture?
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Please share your thoughts in at least 10 words.
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4. Age
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Under 18
19-24
25-34
35-44
45-54
55-64
65+
Prefer not to say
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5. Veteran status
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Veteran
Not a veteran
Prefer not to say
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6. Race and ethnicity
Select as many options as you want or leave all unselected if you’d prefer not to say.
African-American/Black
East Asian, including Chinese, Japanese, Korean, Mongolian, Tibetan, and Taiwanese
Hispanic/LatinX
Middle Eastern
Pacific Islander
South Asian, including Bangladeshi, Bhutanese, Indian, Nepali, Pakistani, and Sri Lankan
Southeast Asian, including Burmese, Cambodian, Filipino, Hmong, Indonesian, Laotian, Malaysian, Mien, Singaporean,
Thai, and Vietnamese
White
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7. Gender identity
Select as many options as you want or leave all unselected if you’d prefer not to say.
Woman
Man
Non-binary/third gender
Prefer to self-describe
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8. Do you identify as transgender?
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Yes
No
Prefer not to say
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9. Sexual orientation
Select as many options as you want or leave all.
Asexual
Bisexual
Gay
Heterosexual
Lesbian
Pansexual
Queer
Other
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10. Family status
No children
Partnered parent/legal guardian
Single parent/legal guardian
Prefer not to say
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11. Ability
Select as many options as you want or leave allunselected if you’d prefer not to say. I identify as…
Having a visible physical disability
Having an invisible physical disability
Having a mental or cognitive disability
Having a mental health disorder
Neuroatypical
None of these apply to me
Other
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