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Workplace Belonging, Inclusion & Psychological Safety Assessment

Measures employee experiences of belonging, perceived inclusion, and psychological safety to identify gaps across teams and track progress over time. Designed for HR and DEI teams conducting periodic organizational assessments.

Sample questions

A preview of what’s in the template. Every question is editable before you launch.

21 questions · ~10 min
Q01
Message

Welcome to the Workplace Belonging & Inclusion Survey. This survey is designed to understand your experiences with belonging, inclusion, and psychological safety at work. Your responses are completely confidential and will be reported only in aggregate — no individual answers will be shared with managers or leadership. There are no right or wrong answers; we are interested in your honest opinions. Participation is voluntary and you may stop at any time. The survey takes approximately 6–8 minutes to complete. By proceeding, you indicate your consent to participate.

Q02
Opinion Scale

How comfortable do you feel being yourself in your day-to-day work environment?

Scale: 17
Min:Not at all comfortableMax:Extremely comfortable
Q03
Opinion Scale

Overall, how inclusive do you find your workplace?

Scale: 17
Min:Not at all inclusiveMax:Extremely inclusive
Q04
Opinion Scale

I feel safe to express a dissenting opinion at work without fear of negative consequences.

Scale: 17
Min:Strongly disagreeMax:Strongly agree
Q05
Opinion Scale

To what extent do you feel you have equal access to professional development and growth opportunities compared to your colleagues?

Scale: 17
Min:Not at all equalMax:Completely equal
Q06
Long Text

Based on your responses throughout this survey, please share any additional thoughts or feelings about belonging and inclusion at this company.

Q07
Message

The following questions help us understand experiences across different groups. All responses are reported in aggregate only.

Q08
Message

Thank you for completing this survey. Your honest feedback is essential to building a more inclusive workplace. Results will be reviewed in aggregate and shared with leadership to inform action planning. If you have concerns you'd like to discuss directly, please contact your HR representative.

Q09
Multiple Choice

Which aspects of the work environment most support your sense of belonging? (Select all that apply)

  • Open communication
  • Team collaboration
  • Flexible work arrangements
  • Diversity and inclusion initiatives
  • Professional development opportunities
  • Supportive management
  • Employee resource groups
  • Other (please specify)
Q10
Opinion Scale

I feel like I truly belong at this organization.

Scale: 17
Min:Strongly disagreeMax:Strongly agree
Q11
Opinion Scale

If I make a mistake at work, it is held against me.

Scale: 17
Min:Strongly disagreeMax:Strongly agree
Q12
Multiple Choice

Which of the following changes would most improve your sense of belonging at work? (Select all that apply)

  • More team connection and social opportunities
  • Clearer and more transparent communication from leadership
  • Recognition and appreciation programs
  • Mentorship and sponsorship opportunities
  • Greater representation in leadership
  • More inclusive meeting practices
  • Bias and inclusion training
  • Other (please specify)
Q13
AI Interview

Thank you for your responses so far. I'd like to explore your experiences with belonging and inclusion in a bit more depth. Could you describe a specific situation at work where you either felt strongly included or felt excluded?

Q14
Dropdown

Which department do you primarily work in?

  • Engineering
  • Product
  • Sales
  • Marketing
  • Operations
  • Human Resources
  • Finance
  • Customer Support
  • Other
  • Prefer not to say
Q15
Opinion Scale

How often do you feel your unique perspectives and contributions are valued by your team?

Scale: 15
Min:NeverMax:Always
Q16
Opinion Scale

I feel comfortable asking for help from my colleagues or manager when I need it.

Scale: 17
Min:Strongly disagreeMax:Strongly agree
Q17
Dropdown

How long have you worked at the company?

  • Less than 6 months
  • 6–12 months
  • 1–3 years
  • 3–5 years
  • More than 5 years
  • Prefer not to say
Q18
Opinion Scale

How often do you feel you can participate fully in team decisions and discussions?

Scale: 15
Min:NeverMax:Always
Q19
Dropdown

What is your current work arrangement?

  • On-site
  • Hybrid
  • Remote
  • Other
  • Prefer not to say
Q20
Opinion Scale

How often do you witness or experience exclusionary behavior in your workplace?

Scale: 15
Min:NeverMax:Very frequently
Q21
Multiple Choice

Are you a people manager?

  • Yes
  • No
  • Prefer not to say

What’s included

  • AI follow-ups

    Adaptive probes on open-ended answers that pull out detail a static form would miss.

  • Attention checks

    Built-in safeguards against rushed answers and low-quality respondents.

  • AI-drafted copy

    Wording, ordering, and branching written by the AI — tuned to your research goal.

  • Auto report

    Themes, quotes, and a plain-English summary write themselves once responses come in.

Ready to launch?

Open this template in the editor. Every part is yours to change before the first respondent sees it.