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Belonging and Inclusion Survey Template

Explore everyday belonging in one team through acceptance, access, voice and participation. Customize seven optional questions with SurveyLegend. Adult employees who have worked in one named team for at least 90 days can use the example to choose one team practice or process to review for stronger everyday belonging and inclusion.

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Explore everyday belonging in one team through acceptance, access, voice and participation. Customize seven optional questions with SurveyLegend. Adult employees who have worked in one named team for at least 90 days can use the example to choose one team practice or process to review for stronger everyday belonging and inclusion.

Focus on Everyday Team Experience

Use this template when a team wants practical feedback about the past 90 days. It asks about access and participation without requesting identity details. For a broader view of motivation, commitment and working life, use the employee engagement template.

When to Use This Template

Use it with adults who have worked in one named team for at least 90 days. Keep the reference period and team visible. This questionnaire is not a demographic census, validated belonging scale, wellbeing assessment, harassment report or investigation channel.

7 Questions for This Template

Use these seven optional questions as a starting point. Respondent introduction: Answer about your experience in the named team during the past 90 days. All questions are optional. Do not name coworkers, disclose protected personal details, or report an urgent incident here.

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A little feedback. A clearer picture.

Explore this 7-question example at your own pace. Every question is optional.

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Belonging and Inclusion Survey

01 How long have you worked in the named team?

Choose one answer, or skip this question.

02 How often have you felt accepted in everyday team interactions?

Choose one answer, or skip this question.

03 How often have you had access to the information or opportunities needed to participate?

Choose one answer, or skip this question.

04 How often have your perspectives been considered in team discussions or decisions?

Choose one answer, or skip this question.

05 How comfortable have you felt contributing a different viewpoint?

Choose one answer, or skip this question.

06 Which area most needs review?

Choose one answer, or skip this question.

07 What one team practice or process would strengthen everyday belonging? Please do not name coworkers or include incident details.

Share your answer, or skip this question.

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How to Customize the Questions

Name the team and explain who will review aggregated results. If identity handling affects candor, state whether responses are anonymous or confidential and consult SurveyLegend’s anonymous feedback guidance. Do not add protected-characteristic questions unless a defined, lawful research need and privacy review support them.

Printable belonging and inclusion survey template

Offer the printable belonging and inclusion survey where staff cannot or prefer not to use an online form. It contains the same seven optional questions and answer choices. Explain the private collection and review process, especially for small teams, and provide separate routes for specific incidents. Paper replies require manual review and do not automatically join online results.

First page of the printable Belonging and Inclusion Survey Template with questions and answer spaces
Download Belonging and Inclusion Survey template PDF

Create This Survey With an AI Prompt

Copy this prompt into an AI assistant to draft the questions. Review the draft, then build and customize the survey in SurveyLegend before sharing.

Copy the prompt into an AI assistant to draft the questions, then build your survey in SurveyLegend.

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How to Use the Answers

Review acceptance, access to information, participation and comfort contributing as related but separate signals. Keep small groups from being identifiable, and route specific incidents through the proper reporting process.

Frequently asked questions

Is this a validated belonging scale?

No. These are original practical questions. Use the researchers’ instrument and scoring only under its stated conditions when validated measurement is required.

Should the survey ask for demographic identity?

Not by default. Add identity fields only when they answer a defined question, privacy safeguards are in place and groups will not become identifiable.

Can this replace an incident report?

No. Give employees a separate, clearly explained route for harassment, discrimination, safety or urgent concerns.

Human Resource and Employee Survey Templates for Satisfaction

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