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Disability and Inclusivity in the Work Place
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
What is your gender identity?
Select one or more answers
Male
Female
Non-binary
Transgender
Prefer not to say
Other (please specify)
2
What is your race/ethnicity? Select all that apply
Select one or more answers
Asian
Black or African American
Hispanic or Latino
Native American or Alaska Native
Native Hawaiian or other Pacific Islander
White
Prefer not to say
Other (please specify)
3
What is your sexual orientation?
Select one or more answers
Heterosexual
Homosexual
Bisexual
Asexual
Prefer not to say
Other (please specify)
4
What is your age?
Select one or more answers
Under 18
18-24
25-34
35-44
45-54
55-64
65 and above
Prefer not to say
5
Do you have a disability?
Select one or more answers
Yes
No
Prefer not to say
6
Are you a Veteran?
Select one or more answers
Yes
No
Prefer not to say
7
Pacheco Autism Center actively promotes diversity and inclusion?
Select one or more answers
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
8
How often do you witness or experience biased behavior in the workplace?
Select one or more answers
Often
Sometimes
Never
9
Do you feel comfortable reporting incidents of bias to leadership?
Select one or more answers
Yes
No
10
Do you feel the interview process is fair and unbiased?
Select one or more answers
Yes
No
11
Have you received training on culture humility?
Select one or more answers
Yes
No
12
Do you feel your leadership team actively promotes inclusivity within your team?
Select one or more answers
Yes
No
13
Do you have any suggestions to improve diversity and inclusion at Pacheco Autism Center?
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