Step
1
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5
20%
On a scale of 1 to 5, how much do you trust your employer to provide a safe and supportive work environment?
Not at all
Slightly
Neutral
Moderately
Completely
How comfortable do you feel being yourself at work?
Very uncomfortable
Somewhat uncomfortable
Neutral
Somewhat comfortable
Very comfortable
How important is being part of a community within your workplace to you?
Not at all important
Slightly important
Neutral
Moderately important
Very important
Do you feel empowered to speak up and share your experiences at work?
Not at all empowered
Slightly empowered
Neutral
Moderately empowered
Very empowered
Would you be willing to participate in an employee advocacy program if there were incentives or recognition programs in place?
Not at all willing
Slightly willing
Neutral
Moderately willing
Very willing
Name
*
First
Last
Email
*
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