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Psychological Safety & Belonging Assessment

Measures team-level psychological safety, belonging, and speak-up culture using Edmondson-informed items. Designed for HR and people teams seeking actionable insights to improve team dynamics.

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Sample questions

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

22 questions · ~10 min
Q01
Message

Welcome to the Team Culture Survey. This survey asks about your experiences with psychological safety and belonging on your team. Your responses are completely anonymous and will be reported only in aggregate—no individual answers will be shared with your manager 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. Estimated time: 10 minutes.

Q02
Opinion Scale

Overall, how safe do you feel expressing your honest opinions with your team?

Scale: 1 – 7
Min:Not at all safeMax:Extremely safe
Q03
Opinion Scale

I feel like I truly belong on my team.

Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q04
Multiple Choice

In the last 30 days, have you shared a new idea or concern at work?

  • Yes
  • No
Q05
AI Interview

Thinking about your experiences on your team, what would most help you feel safer speaking up, sharing ideas, or feeling like you belong?

Q06
Dropdown

Which team do you primarily work with?

  • Engineering
  • Product
  • Design
  • Sales
  • Marketing
  • Customer Support
  • Operations
  • HR / People
  • Finance
  • IT
  • Other
Q07
Long Text

What country or region do you primarily work from?

Q08
Message

Thank you for completing this survey. Your responses are anonymous and will be used in aggregate to help improve how our teams work together. If you have any concerns about this survey, please contact your People team.

Q09
Opinion Scale

Members of my team are able to bring up problems and tough issues.

Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q10
Opinion Scale

I feel accepted for who I am by my team members.

Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q11
Opinion Scale

When you share ideas or concerns, how is your input typically received?

Scale: 1 – 7
Min:Dismissed or ignoredMax:Valued and acted upon
Q12
Long Text

Based on your responses in this survey, please share any additional thoughts or feelings about your team's culture, psychological safety, or belonging.

Q13
Dropdown

How long have you been with the company?

  • Less than 3 months
  • 3–12 months
  • 1–3 years
  • 3–5 years
  • More than 5 years
Q14
Dropdown

What is your age range?

  • Under 20
  • 20–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65 or older
  • Prefer not to say
Q15
Opinion Scale

If I make a mistake on this team, it is not held against me.

Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q16
Opinion Scale

I feel comfortable raising issues or concerns directly with my manager.

Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q17
Dropdown

Which best describes your current role level?

  • Individual contributor
  • Manager (people manager)
  • Director
  • Executive
  • Other
Q18
Multiple Choice

How do you describe your gender? (Select all that apply)

  • Man
  • Woman
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q19
Opinion Scale

It is easy to ask other members of my team for help.

Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree
Q20
Multiple Choice

Where do you most often share ideas or concerns? (Select all that apply)

  • 1:1 with my manager
  • Team meetings
  • Cross-functional meetings
  • Anonymous channels
  • Surveys
  • Chat tools (e.g., Slack, Teams)
  • Ticket or idea portal
  • Other
Q21
Dropdown

What is your primary work arrangement?

  • On-site
  • Hybrid
  • Fully remote
Q22
Opinion Scale

People on my team value and respect each other's contributions.

Scale: 1 – 7
Min:Strongly disagreeMax:Strongly agree

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 adaptive AI follow-up interview question that lets employees expand in their own words on what would help them feel safer speaking up, beyond fixed rating scales
  • Combines Edmondson-informed psychological safety items (mistakes not held against you, ability to raise tough issues) with distinct belonging items (feeling accepted, feeling like you truly belong) rather than treating them as one construct
  • Captures behavioral data (whether an idea/concern was actually shared in the last 30 days, and where) alongside attitudinal opinion-scale items, giving both perception and behavior signals
  • Pairs quantitative opinion-scale and dropdown demographic segmentation (team, tenure, role level, work arrangement) with open-text and AI-interview responses for richer, HR-ready qualitative context

QuestionPro

Psychological Safety Survey Questions + Sample Questionnaire Template

This is a genuinely comparable offering: a sample psychological safety questionnaire aimed at workplace/HR use, in the same conceptual space as Edmondson's framework. It reads as a static question-bank/template page rather than a fielding-ready adaptive survey with built-in scoring or interview logic.

What it does well

  • Established survey platform with a large question template library to draw from
  • Provides sample questionnaire structure specifically framed around psychological safety
  • Likely supports standard reporting and cross-tabulation tools common to enterprise survey platforms

Where it falls short

  • Fixed question set with no adaptive AI follow-up probing based on individual responses
  • No voice AI interview option or guided screen-share tasks
  • No indication of automated per-response quality scoring or transparent, published prompt methodology

Frequently asked questions

What questions are in the “Psychological Safety & Belonging Assessment” template?

The template includes 22 ready-to-use questions, starting with: “Welcome to the Team Culture Survey. This survey asks about your experiences with psychological safety and belonging on y…” · “Overall, how safe do you feel expressing your honest opinions with your team?” · “I feel like I truly belong on my team.”. The full set is previewed above, and every question is editable.

How long does this survey take to complete?

Respondents typically finish the 22 questions in about 10 minutes.

Can I customize this template?

Yes — every question, answer option, and the ordering is editable before you launch. You can add or remove questions, or ask the AI editor to rework the survey around your research goal.

Is this template free to use?

Yes. Open it in the editor and start customizing right away — no account required to try it, and the free plan covers launching your survey.

Ready to launch?

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

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