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Racism in the Workplace: Employee Check-In Survey

Measures how employees experience or witness racism and racial bias at work, how safe they feel raising concerns, and whether leadership follows through on accountability. An AI follow-up interview probes the real story behind low safety ratings or unreported incidents, surfacing details a scale score alone can't capture.

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Sample questions

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

13 questions · ~7 min
Q01
Message

Thanks for taking a few minutes for this check-in. We're asking about experiences with racism and racial bias at work so we can address gaps honestly. Your responses are confidential and you can skip anything you'd rather not answer. About 6 minutes.

Q02
Multiple Choice

In the last 6 months, have you personally experienced or witnessed racism or racial bias at work?

  • Yes, I personally experienced it
  • Yes, I witnessed it happen to someone else
  • Both experienced and witnessed
  • No
  • Prefer not to say
Q03
Opinion ScaleRequired

How safe do you feel raising a concern about racism or racial bias with your manager or HR?

Scale: 1 – 5
Min:Not at all safeMax:Extremely safe
Q04
MatrixRequired

How much do you agree with each statement about how our company handles racism and inclusion?

5 rows × 5 columns
  • My manager addresses racist behavior when it occurs
  • Leadership takes concerns about racism seriously
  • People of all racial backgrounds have equal opportunities for advancement here
  • I have seen colleagues held accountable for racist remarks or actions
  • I know how to report a racism-related concern
Columns: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q05
Multiple Choice

In the last 6 months, which of these have you personally experienced at work? Select all that apply.

  • Being excluded from meetings, projects, or decisions
  • Racial jokes, stereotypes, or slurs directed at me or in my presence
  • Being mistaken for another colleague of the same race
  • Assumptions about my competence or role based on my race
  • Being passed over for opportunities I believe were race-related
Q06
Best–Worst Trade-off (MaxDiff)Required

Which of these actions should our company prioritize to address racism and improve inclusion?

  • Mandatory training on bias and inclusive behavior
  • A clear, confidential process for reporting incidents
  • Diverse representation on hiring panels
  • Managers held accountable for addressing racist behavior
  • Active employee resource groups for underrepresented employees
  • Transparent, published promotion criteria
  • Visible commitment from senior leadership
Pick best & worst per setBest:Most important to prioritizeWorst:Least important right now
Q07
Opinion Scale

How likely are you to recommend this company as an inclusive place to work to a friend from an underrepresented racial or ethnic background?

Scale: 0 – 10
Min:Not at all likelyMax:Extremely likely
Q08
AI Interview

Explore the reasoning behind the respondent's safety rating and any racism-related experiences they reported. If they rated safety low (1-2) or selected an experience above, probe what specifically happened, whether they reported it, why or why not, and what response (if any) came from their manager or HR. If they rated safety high, ask what concretely makes them feel supported. If they said they witnessed but did not experience racism, ask what stopped them from intervening or reporting it.

Q09
Long Text

Is there anything else about race, racism, or inclusion at work you'd like us to know? (Optional)

Q10
Multiple Choice

How would you describe your race or ethnicity? (Optional — used only to identify patterns across groups)

  • American Indian or Alaska Native
  • Asian
  • Black or African American
  • Hispanic or Latino
  • Native Hawaiian or Other Pacific Islander
  • White
  • Multiracial or biracial
  • Another race or ethnicity not listed
  • Prefer not to say
Q11
Multiple Choice

How long have you worked at the company?

  • Less than 6 months
  • 6 months to 1 year
  • 1 to 3 years
  • 3 to 5 years
  • 5+ years
  • Prefer not to say
Q12
Short Text

What department or team are you part of? (Optional)

Q13
Message

Thank you for your honesty. Responses are reviewed in aggregate by HR and leadership to identify patterns and shape concrete action — individual answers are never shared with your 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.

How it compares

We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.

Why this template

  • Includes an AI follow-up interview that specifically probes the reasoning behind low safety ratings or reported incidents, going beyond scale scores to surface real context
  • Combines quantitative measures (opinion scales, matrix, max-diff prioritization) with open-ended and adaptive follow-up so both breadth and depth are captured in one flow
  • Closes with a transparent chat message explaining that responses are reviewed in aggregate by HR and leadership, supporting trust in a sensitive topic
  • Offers optional demographic and tenure questions clearly marked optional, letting respondents control disclosure while still enabling equity analysis

SurveyMonkey

Impact Of Racism Employee Check-In Survey Template

This is a directly comparable, ready-to-field template addressing the same core topic — racism and racial bias in the workplace. It's built on SurveyMonkey's established survey infrastructure, which is a genuine strength for quick deployment and benchmarking. However, it appears to be a static question set without any mechanism for probing deeper into individual responses.

What it does well

  • Built on a well-established, widely used survey platform
  • Purpose-built specifically for measuring racism/DEI issues rather than generic feedback
  • Likely benefits from SurveyMonkey's broader survey design and distribution tooling

Where it falls short

  • No adaptive AI follow-up to probe the story behind a low safety score or an unreported incident — respondents get a fixed question set
  • No voice AI interview option for employees who prefer speaking over typing
  • No indication of automated per-response quality scoring or transparent, published prompt methodology

Ready to launch?

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