Q01
Long Text
All templates
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 · ~4 min
Q02
Long Text
How comfortable do you feel being yourself in your day-to-day work environment?
Q03
Long Text
Overall, how inclusive do you find your workplace?
Q04
Long Text
I feel safe to express a dissenting opinion at work without fear of negative consequences.
Q05
Long Text
To what extent do you feel you have equal access to professional development and growth opportunities compared to your colleagues?
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
Long Text
The following questions help us understand experiences across different groups. All responses are reported in aggregate only.
Q08
Long Text
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)
Q10
Long Text
I feel like I truly belong at this organization.
Q11
Long Text
If I make a mistake at work, it is held against me.
Q12
Multiple Choice
Which of the following changes would most improve your sense of belonging at work? (Select all that apply)
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
Long Text
Which department do you primarily work in?
Q15
Long Text
How often do you feel your unique perspectives and contributions are valued by your team?
Q16
Long Text
I feel comfortable asking for help from my colleagues or manager when I need it.
Q17
Long Text
How long have you worked at the company?
Q18
Long Text
How often do you feel you can participate fully in team decisions and discussions?
Q19
Long Text
What is your current work arrangement?
Q20
Long Text
How often do you witness or experience exclusionary behavior in your workplace?
Q21
Multiple Choice
Are you a people manager?
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.