This printable diversity and inclusion survey helps organizations measure how included and respected their people feel, using 8 questions across one anonymous page. 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. A rating grid captures agreement on belonging, psychological safety, leadership commitment, and openness to different perspectives. A single overall culture rating gives you a simple metric to track over time, and an open comment box invites 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.