Diversity Inclusion Scenario Assessment Form

Diversity Inclusion Scenario Assessment Form
Assess how a respondent would handle workplace diversity and inclusion scenarios using ratings, single-choice answers, and a response table.
Scenario Context
Respondent Name
Role or Department
Scenario Category
Other
Assessment Responses
Scenario understanding

1
2
3
4
5
6
7
8
9
10
1 is Low understanding, 10 is High understanding
Inclusion impact

1
2
3
4
5
1 is Negative impact, 5 is Positive impact
Best response to the scenario
Other
How often do you apply inclusive practices?

1
2
3
4
5
1 is Rarely, 5 is Always
Actions you would take
Rows Yes No Maybe
Listen first
Use inclusive language
Check for bias
Invite perspectives
Escalate concerns when needed
Reflection and Follow-up
Reflection on key learning or rationale
Follow-up preference
Should be Empty:

Select theme:

Rows	Yes	No	Maybe
Listen first
Use inclusive language
Check for bias
Invite perspectives
Escalate concerns when needed