Sustainability Impact Index Survey Form
Help us assess your organization's sustainability practices across environmental, social, and governance dimensions.
Organization Name
*
Contact Person Full Name
*
First Name
Last Name
Contact Email Address
*
example@example.com
Organization Type
*
Please Select
Corporation
Non-Profit
Educational Institution
Government Agency
Small/Medium Enterprise
Other
Organization Size (number of employees)
*
Please Select
1-10
11-50
51-200
201-500
501+
Please rate your organization's practices in the following sustainability areas.
*
Rows
Not Practiced
In Progress
Partially Implemented
Fully Implemented
Energy Efficiency Initiatives
1
2
3
4
Waste Reduction & Recycling
5
6
7
8
Water Conservation
9
10
11
12
Sustainable Procurement
13
14
15
16
Carbon Emission Monitoring
17
18
19
20
Which of the following social responsibility practices does your organization actively engage in? (Select all that apply)
*
Employee Diversity & Inclusion Programs
Community Engagement/Outreach
Employee Wellbeing & Health Initiatives
Ethical Labor Practices
Fair Trade Sourcing
Other
How would you rate your organization's transparency and governance in sustainability reporting?
*
1
2
3
4
5
Does your organization publish an annual sustainability or ESG report?
*
Yes
No
Planning to Start
Overall, how would you rate your organization's sustainability impact?
*
Minimal Impact
1
2
3
4
5
6
7
8
9
Significant Impact
10
1 is Minimal Impact, 10 is Significant Impact
Please provide any additional comments or suggestions for improving your sustainability impact.
Submit Survey
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