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.
How comfortable do you feel being yourself in your day-to-day work environment?
Overall, how inclusive do you find your workplace?
I feel safe to express a dissenting opinion at work without fear of negative consequences.
To what extent do you feel you have equal access to professional development and growth opportunities compared to your colleagues?
Based on your responses throughout this survey, please share any additional thoughts or feelings about belonging and inclusion at this company.
The following questions help us understand experiences across different groups. All responses are reported in aggregate only.
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.
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)
I feel like I truly belong at this organization.
If I make a mistake at work, it is held against me.
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)
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?
Which department do you primarily work in?
- Engineering
- Product
- Sales
- Marketing
- Operations
- Human Resources
- Finance
- Customer Support
- Other
- Prefer not to say
How often do you feel your unique perspectives and contributions are valued by your team?
I feel comfortable asking for help from my colleagues or manager when I need it.
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
How often do you feel you can participate fully in team decisions and discussions?
What is your current work arrangement?
- On-site
- Hybrid
- Remote
- Other
- Prefer not to say
How often do you witness or experience exclusionary behavior in your workplace?
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.
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
- Combines validated opinion-scale items on belonging, inclusion, and psychological safety (e.g., comfort being oneself, safety to dissent, mistakes being held against you) with demographic breakdowns by department, tenure, and manager status to spot gaps across teams
- Includes an AI follow-up interview that adaptively probes deeper into a respondent's belonging and inclusion experiences after the scaled questions, going beyond static ratings
- Captures both quantitative trend data (for tracking progress over time) and open-text reflection plus multiple-choice questions on which changes would most improve belonging, giving HR/DEI teams actionable qualitative context
- Automated per-response quality scoring and auto-generated reporting reduce manual analysis work for HR and DEI teams running periodic assessments
QuestionPro
Psychological Safety Survey Questions + Sample Questionnaire TemplateA questionnaire template and question bank focused specifically on psychological safety, likely paired with QuestionPro's broader survey and analytics platform. It appears oriented toward providing sample questions rather than a fully adaptive interview experience. Useful as a static question reference but narrower in scope than a combined belonging/inclusion/psych-safety assessment.
What it does well
- Dedicated, topic-specific focus on psychological safety with sample questions
- Backed by an established survey platform with broad analytics and reporting features
- Likely offers customizable question libraries for HR teams
Where it falls short
- No adaptive AI follow-up probing — respondents answer fixed questions with no dynamic follow-up on their specific answers
- No indication of a voice-based interview option
- No published methodology showing how questions map to psychological safety constructs
SurveyMonkey
Belonging And Inclusion Survey TemplateA ready-to-field template covering belonging and inclusion themes, built on SurveyMonkey's widely used survey infrastructure. It's a static questionnaire format aimed at general audiences rather than one purpose-built for DEI teams tracking psychological safety specifically. Good for quick deployment but limited in depth of follow-up.
What it does well
- Fielding-ready template on a well-known, easy-to-use survey platform
- Likely includes benchmarking or reporting tools common to SurveyMonkey
- Simple setup suited for quick organizational pulse checks
Where it falls short
- Static question set with no adaptive AI interview or guided task capability
- No voice AI interview option for richer qualitative capture
- No transparent, inspectable prompt/methodology behind question selection
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.