At Holistic, we take a different approach to identity. We believe that an employee does not need a company to tell them how they should identify -- an employee can do so themselves.

Our tools will process self-identified information and analyze this data and use it for productive, educational purposes. In doing so, we receive stronger and more accurate responses from individuals that engenders more participation, understanding, and opportunity for the company.

With this in mind and knowing the delicate nature of diversity, equity, and inclusion questions, we ask that you share whatever you feel comfortable with in the following survey. Please keep in mind all submitted information will remain anonymous. However, we hope you will use this as an opportunity to share with your colleagues and teammates at your company the diversity of perspective, and encourage each employee to identify where they can learn and grow.

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* 1. Company Name

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* 2. Please tell us how you identify on the following demographic indicators: race, gender, age, and job function.

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* 3. Please tell us how else you identify.
Please be creative and thorough -- we would like to know what is important to you. A few examples include sexual orientation, religious beliefs, marital status, parental status, veteran status or active military service, disability status, education, national origin, work style, personality, or any other community or identity you affiliate with and would like to share with us.

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* 4. What is your understanding of the term “microaggression”?

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* 5. What behaviors or actions do you associate with the term “microaggression”?

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* 6. How often, if at all, do you believe you are the victim of microaggressions at work?

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* 7. How often, if at all, have you experienced any of the following at work?

  Never Rarely Unsure Occasionally Frequently N/A
Had others make assumptions about my race, gender, or sexual orientation
Been told that I do not act like a member of a certain identity I associate with
Had others make assumptions about my education or socioeconomic background
Been asked to speak as a representative on behalf of my identity
Been made to feel like I do not belong in this country or at this company
Had others react in discomfort to me because of who I am
Heard others make off-color statements or jokes about a group of people
Heard others say “I don’t see race”, or comments to this effect
Had others point out things about my personal or professional experience
Had others make comments about the way I speak or express myself
Had a coworker or colleague take credit for my ideas or work
Been excluded from important meetings, intentionally or unintentionally
Been talked over or made to feel that my opinion was unimportant or not desired
Felt unwelcome in certain social gatherings at work or work-related functions
Felt that my work was held to higher levels of scrutiny because of who I am

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* 8. Is there anything that we did not include in the above list that you feel should be included?

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* 9. Please identify any relevant audiences, if any, that may have made remarks or actions that caused you to feel misunderstood or excluded.
Please select all that apply.

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* 10. What steps, if any, are you aware of that your company is taking to create a more inclusive working environment? What would you like to see?

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* 11. Please rate your response to the following statement:

“I feel that I can fully be myself at work.”

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* 12. How likely are you to recommend working at your company to a friend?

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