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Inclusion & belonging

Inclusion and belonging survey template

Anonymous measure of respect, voice, fairness and belonging, with optional self-described demographics.

5 questions · about 4 minutes to complete · free on every plan

More employee feedback templates

Free account required. The template is copied into your workspace; edit anything before publishing.

When to use it
Once a year, separately from the engagement survey.
Who it is for
All employees, anonymously.

How to use this template

  1. Keep it anonymous unless you need to follow up, and say so in the intro.
  2. Report by group only where there are at least ten responses.
  3. Pair every score with one concrete commitment.

Questions in the inclusion and belonging survey template

  1. 1. At work…

    matrix · I can be myself, My opinions are heard and valued, People from all backgrounds are treated fairly, I feel a sense of belonging on my team, Leaders take inclusion seriously, I would feel safe reporting disrespectful behaviour

  2. 2. In the last year, have you seen or experienced behaviour here that felt disrespectful or exclusionary?

    single choice · No, Yes, once, Yes, more than once, Prefer not to say

  3. 3. What would make this a more inclusive place to work?

    open text

  4. 4. Which age group are you in?

    single choice · Under 18, 18–24, 25–34, 35–44, 45–54, 55–64, 65 or over, Prefer not to say

  5. 5. How do you describe your gender?

    single choice · Woman, Man, Non-binary, Prefer to self-describe, Prefer not to say

What the results look like

IllustrativeSynthetic sample of 120 responses generated for this preview, not real survey data. Your results page shows the same charts for your own responses.

1.At work…

120 answered
StatementStrongly disagreeDisagreeNeutralAgreeStrongly agreen
I can be myself8%7%22%23%41%120
My opinions are heard and valued3%11%19%28%39%120
People from all backgrounds are treated fairly6%13%24%28%29%120
I feel a sense of belonging on my team7%17%24%18%34%120
Leaders take inclusion seriously10%12%19%24%35%120
I would feel safe reporting disrespectful behaviour8%21%14%23%35%120

2.In the last year, have you seen or experienced behaviour here that felt disrespectful or exclusionary?

120 answered
Answer distribution
AnswerCountPercent
No3428%
Yes, once2521%
Yes, more than once3428%
Prefer not to say2723%

3.Which age group are you in?

120 answered
Answer distribution
AnswerCountPercent
Under 181815%
18–2487%
25–3476%
35–441412%
45–5487%
55–641210%
65 or over2420%
Prefer not to say2924%

4.How do you describe your gender?

111 answered
Answer distribution
AnswerCountPercent
Woman2623%
Man1110%
Non-binary98%
Prefer to self-describe3128%
Prefer not to say3431%

How to read these questions

  • matrix: Compare rows on the same column (for example, % agree) to find the weakest statement, then look at who rates it lowest.
  • single choice: Read the share choosing each option, then cross-tab by a segment question to see who differs.

Frequently asked questions

Should an inclusion survey collect demographic data?

Only optional, self-described questions, and only if you will report by group with a minimum group size. Make clear that every demographic question can be skipped.

How long does the inclusion and belonging survey take to complete?

About 4 minutes: 5 questions, most of them single-tap. Every question can be edited, removed or reordered in the builder before you publish.

Is this template free to use?

Yes. Every template is included on the Free plan. Sign up, click Use this template, and it is copied into your workspace where you can edit it, add your logo and share it by link, email or embed.

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