Diversity and Inclusion Impact Assessment Form
Help us evaluate and improve our organization's diversity and inclusion efforts by providing your honest feedback.
Please provide your full name (optional):
First Name
Last Name
Department/Team
*
Please Select
Human Resources
Finance
Operations
Sales/Marketing
IT/Technology
Other
What is your primary role within the organization?
*
Please Select
Executive/Leadership
Manager/Supervisor
Staff/Employee
Intern/Temporary
Other
Please indicate the extent to which you agree with the following statements about diversity and inclusion in our organization:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The organization values diversity in its workforce.
1
2
3
4
5
All employees are treated with respect and fairness.
6
7
8
9
10
I feel included and accepted in my workplace.
11
12
13
14
15
There are equal opportunities for advancement for all employees.
16
17
18
19
20
The organization actively promotes diversity and inclusion.
21
22
23
24
25
How would you rate the effectiveness of the following diversity and inclusion initiatives in our organization?
*
Rows
Very Ineffective
Ineffective
Neutral
Effective
Very Effective
Diversity training programs
26
27
28
29
30
Employee resource/support groups
31
32
33
34
35
Inclusive recruitment practices
36
37
38
39
40
Mentoring/coaching opportunities
41
42
43
44
45
Anti-discrimination policies
46
47
48
49
50
Overall, how would you rate the organization's commitment to diversity and inclusion?
*
1
2
3
4
5
Have you personally experienced or witnessed any discrimination or exclusion in the workplace within the past year?
*
Yes
No
Prefer not to say
What additional actions do you believe the organization could take to improve diversity and inclusion?
If you would like to, please share any personal experiences or suggestions related to diversity and inclusion in our organization:
Submit Assessment
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