This printable diversity and inclusion survey helps organizations measure how included and respected their people feel, using 19 questions across three anonymous pages. It gives every employee a voice, including frontline and deskless staff who rarely open an email survey.
What this survey measures
The questions cover the core dimensions of a healthy DEI climate: whether people feel respected and valued, whether opportunities are truly equal, and whether staff feel comfortable being themselves at work. Agreement grids cover belonging and psychological safety, and fairness in pay, promotion, training and standards. A rating grid looks at leadership commitment, manager support, policies and how complaints are handled, and staff can choose the initiatives they would like to see more of. An overall inclusion rating gives you a simple metric to track over time, alongside questions on whether things are improving, experiences of discrimination, whether they were reported and whether staff know how to report them. Two open comment boxes invite concrete suggestions the fixed questions might miss.
How to use it on paper
Hand the survey out during team meetings, all-hands sessions, or onboarding, or leave copies in break rooms with an anonymous drop box. Ask staff to fill the checkboxes with a blue or black pen and to leave the form unsigned so responses stay confidential. Collect the completed forms and scan them in batches: PaperSurvey reads the checkbox answers with optical mark recognition and converts the handwritten comments to text automatically, so results appear in your dashboard without any manual data entry.
Customize this template
Add your organization logo, reword the statements to match your values, or add questions about specific teams, locations, or demographic groups. The paper layout reflows automatically as you edit, and every copy you print stays scannable.
Preview the PDF above, or use this template to start listening to your people today.