Workplace Belonging Questionnaire

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* 1. Gender: How do you identify?

Man

Non-binary

Woman

Prefer to self-describe, below

Self-describe:

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* 2. What is your race or ethnicity?

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Multiracial or Multiethnic

Native American or Alaska Native

Native Hawaiian or other Pacific Islander

White

Another race or ethnicity, please describe below

Self-describe below:

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* 3. What is your sexual orientation?

Asexual

Bisexual

Gay

Heterosexual or straight

Lesbian

Pansexual

Queer

None of the above, please specify

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* 4. What is your job role?

Part-Time Employee

Other Full-Time Employee

Team Leader/Unit Head

Manager (Asst, Regional, Sr...)

Vice President/C-Suite

CEO/President or equivalent

Intern/Volunteer

Other

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* 5. What's the highest level of education you've completed, to date?

High school diploma/GED or equivalent

Associates degree

Masters degree

Doctorate or first-professional degree (e.g., PhD, JD, DMin)

Other (please specify)

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* 6. Which of the following best describes the principal industry of your organization?

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* 7. Use this 5-point scale to rate your agreement with the following statements:

	No: Strongly DISAGREE	2	3: Unsure/Neutral	4	Yes: Strongly AGREE
My employer makes good use of my skills and abilities.	My employer makes good use of my skills and abilities. No: Strongly DISAGREE	My employer makes good use of my skills and abilities. 2	My employer makes good use of my skills and abilities. 3: Unsure/Neutral	My employer makes good use of my skills and abilities. 4	My employer makes good use of my skills and abilities. Yes: Strongly AGREE
I feel happy at work.	I feel happy at work. No: Strongly DISAGREE	I feel happy at work. 2	I feel happy at work. 3: Unsure/Neutral	I feel happy at work. 4	I feel happy at work. Yes: Strongly AGREE
I am generally satisfied as an employee.	I am generally satisfied as an employee. No: Strongly DISAGREE	I am generally satisfied as an employee. 2	I am generally satisfied as an employee. 3: Unsure/Neutral	I am generally satisfied as an employee. 4	I am generally satisfied as an employee. Yes: Strongly AGREE
My employer positively recognizes my work and contribution(s) to the team.	My employer positively recognizes my work and contribution(s) to the team. No: Strongly DISAGREE	My employer positively recognizes my work and contribution(s) to the team. 2	My employer positively recognizes my work and contribution(s) to the team. 3: Unsure/Neutral	My employer positively recognizes my work and contribution(s) to the team. 4	My employer positively recognizes my work and contribution(s) to the team. Yes: Strongly AGREE
I feel a sense of belonging at work.	I feel a sense of belonging at work. No: Strongly DISAGREE	I feel a sense of belonging at work. 2	I feel a sense of belonging at work. 3: Unsure/Neutral	I feel a sense of belonging at work. 4	I feel a sense of belonging at work. Yes: Strongly AGREE
I trust my co-workers at work.	I trust my co-workers at work. No: Strongly DISAGREE	I trust my co-workers at work. 2	I trust my co-workers at work. 3: Unsure/Neutral	I trust my co-workers at work. 4	I trust my co-workers at work. Yes: Strongly AGREE
Barring promotion, I plan to stay in my current role for the foreseeable future.	Barring promotion, I plan to stay in my current role for the foreseeable future. No: Strongly DISAGREE	Barring promotion, I plan to stay in my current role for the foreseeable future. 2	Barring promotion, I plan to stay in my current role for the foreseeable future. 3: Unsure/Neutral	Barring promotion, I plan to stay in my current role for the foreseeable future. 4	Barring promotion, I plan to stay in my current role for the foreseeable future. Yes: Strongly AGREE

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* 8. Use the 5-point scale to rate your agreement with the following statements:

	No: 1-Strongly DISAGREE	2	3: Unsure/Neutral	4	Yes: 5-Strongly AGREE
I feel emotionally drained at work.	I feel emotionally drained at work. No: 1-Strongly DISAGREE	I feel emotionally drained at work. 2	I feel emotionally drained at work. 3: Unsure/Neutral	I feel emotionally drained at work. 4	I feel emotionally drained at work. Yes: 5-Strongly AGREE
Working at my current employer causes me a lot of stress.	Working at my current employer causes me a lot of stress. No: 1-Strongly DISAGREE	Working at my current employer causes me a lot of stress. 2	Working at my current employer causes me a lot of stress. 3: Unsure/Neutral	Working at my current employer causes me a lot of stress. 4	Working at my current employer causes me a lot of stress. Yes: 5-Strongly AGREE
I feel accepted by others at work, just as I am.	I feel accepted by others at work, just as I am. No: 1-Strongly DISAGREE	I feel accepted by others at work, just as I am. 2	I feel accepted by others at work, just as I am. 3: Unsure/Neutral	I feel accepted by others at work, just as I am. 4	I feel accepted by others at work, just as I am. Yes: 5-Strongly AGREE
In terms of work, I am burnt out.	In terms of work, I am burnt out. No: 1-Strongly DISAGREE	In terms of work, I am burnt out. 2	In terms of work, I am burnt out. 3: Unsure/Neutral	In terms of work, I am burnt out. 4	In terms of work, I am burnt out. Yes: 5-Strongly AGREE
I feel safe at work.	I feel safe at work. No: 1-Strongly DISAGREE	I feel safe at work. 2	I feel safe at work. 3: Unsure/Neutral	I feel safe at work. 4	I feel safe at work. Yes: 5-Strongly AGREE
I feel like a valued member of the team at work.	I feel like a valued member of the team at work. No: 1-Strongly DISAGREE	I feel like a valued member of the team at work. 2	I feel like a valued member of the team at work. 3: Unsure/Neutral	I feel like a valued member of the team at work. 4	I feel like a valued member of the team at work. Yes: 5-Strongly AGREE
I derive a sense of joy and fulfillment from my job at work.	I derive a sense of joy and fulfillment from my job at work. No: 1-Strongly DISAGREE	I derive a sense of joy and fulfillment from my job at work. 2	I derive a sense of joy and fulfillment from my job at work. 3: Unsure/Neutral	I derive a sense of joy and fulfillment from my job at work. 4	I derive a sense of joy and fulfillment from my job at work. Yes: 5-Strongly AGREE
I worry a lot about my job security at work.	I worry a lot about my job security at work. No: 1-Strongly DISAGREE	I worry a lot about my job security at work. 2	I worry a lot about my job security at work. 3: Unsure/Neutral	I worry a lot about my job security at work. 4	I worry a lot about my job security at work. Yes: 5-Strongly AGREE
I feel proud to work at my current place of employment.	I feel proud to work at my current place of employment. No: 1-Strongly DISAGREE	I feel proud to work at my current place of employment. 2	I feel proud to work at my current place of employment. 3: Unsure/Neutral	I feel proud to work at my current place of employment. 4	I feel proud to work at my current place of employment. Yes: 5-Strongly AGREE

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* 9. Use the 5-point scale to rate your agreement with the following statements:

	No: 1-Strongly DISAGREE	2	3: Unsure/Neutral	4	Yes: 5-Strongly AGREE
It is clear that my supervisor and/or colleagues care about me.	It is clear that my supervisor and/or colleagues care about me. No: 1-Strongly DISAGREE	It is clear that my supervisor and/or colleagues care about me. 2	It is clear that my supervisor and/or colleagues care about me. 3: Unsure/Neutral	It is clear that my supervisor and/or colleagues care about me. 4	It is clear that my supervisor and/or colleagues care about me. Yes: 5-Strongly AGREE
I expect to earn/receive a "high" performance evaluation score this year.	I expect to earn/receive a "high" performance evaluation score this year. No: 1-Strongly DISAGREE	I expect to earn/receive a "high" performance evaluation score this year. 2	I expect to earn/receive a "high" performance evaluation score this year. 3: Unsure/Neutral	I expect to earn/receive a "high" performance evaluation score this year. 4	I expect to earn/receive a "high" performance evaluation score this year. Yes: 5-Strongly AGREE
Leaders are made, not born.	Leaders are made, not born. No: 1-Strongly DISAGREE	Leaders are made, not born. 2	Leaders are made, not born. 3: Unsure/Neutral	Leaders are made, not born. 4	Leaders are made, not born. Yes: 5-Strongly AGREE
Leadership can be developed through effort, feedback, and training.	Leadership can be developed through effort, feedback, and training. No: 1-Strongly DISAGREE	Leadership can be developed through effort, feedback, and training. 2	Leadership can be developed through effort, feedback, and training. 3: Unsure/Neutral	Leadership can be developed through effort, feedback, and training. 4	Leadership can be developed through effort, feedback, and training. Yes: 5-Strongly AGREE
Managers at my job value my input and feedback.	Managers at my job value my input and feedback. No: 1-Strongly DISAGREE	Managers at my job value my input and feedback. 2	Managers at my job value my input and feedback. 3: Unsure/Neutral	Managers at my job value my input and feedback. 4	Managers at my job value my input and feedback. Yes: 5-Strongly AGREE
In my opinion, work is distributed evenly or fairly across my team/unit.	In my opinion, work is distributed evenly or fairly across my team/unit. No: 1-Strongly DISAGREE	In my opinion, work is distributed evenly or fairly across my team/unit. 2	In my opinion, work is distributed evenly or fairly across my team/unit. 3: Unsure/Neutral	In my opinion, work is distributed evenly or fairly across my team/unit. 4	In my opinion, work is distributed evenly or fairly across my team/unit. Yes: 5-Strongly AGREE
My employer offers adequate opportunities for promotions and career advancement.	My employer offers adequate opportunities for promotions and career advancement. No: 1-Strongly DISAGREE	My employer offers adequate opportunities for promotions and career advancement. 2	My employer offers adequate opportunities for promotions and career advancement. 3: Unsure/Neutral	My employer offers adequate opportunities for promotions and career advancement. 4	My employer offers adequate opportunities for promotions and career advancement. Yes: 5-Strongly AGREE
My employer gives me the tools and technologies I need to do my job well.	My employer gives me the tools and technologies I need to do my job well. No: 1-Strongly DISAGREE	My employer gives me the tools and technologies I need to do my job well. 2	My employer gives me the tools and technologies I need to do my job well. 3: Unsure/Neutral	My employer gives me the tools and technologies I need to do my job well. 4	My employer gives me the tools and technologies I need to do my job well. Yes: 5-Strongly AGREE

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* 10. Use the scale to rate the extent to which you engage in the following activities PER WEEK:

	1: Never, 0 hours	2: 1-5 hours	3: 6-10 hours	4: 11-15 hours	5: 16 or more hours
Reading/responding to email.	Reading/responding to email. 1: Never, 0 hours	Reading/responding to email. 2: 1-5 hours	Reading/responding to email. 3: 6-10 hours	Reading/responding to email. 4: 11-15 hours	Reading/responding to email. 5: 16 or more hours
Meeting with others at work via Teams, Zoom, or in-person.	Meeting with others at work via Teams, Zoom, or in-person. 1: Never, 0 hours	Meeting with others at work via Teams, Zoom, or in-person. 2: 1-5 hours	Meeting with others at work via Teams, Zoom, or in-person. 3: 6-10 hours	Meeting with others at work via Teams, Zoom, or in-person. 4: 11-15 hours	Meeting with others at work via Teams, Zoom, or in-person. 5: 16 or more hours
Writing reports or other documents related to my job.	Writing reports or other documents related to my job. 1: Never, 0 hours	Writing reports or other documents related to my job. 2: 1-5 hours	Writing reports or other documents related to my job. 3: 6-10 hours	Writing reports or other documents related to my job. 4: 11-15 hours	Writing reports or other documents related to my job. 5: 16 or more hours
Holding other people accountable for their work.	Holding other people accountable for their work. 1: Never, 0 hours	Holding other people accountable for their work. 2: 1-5 hours	Holding other people accountable for their work. 3: 6-10 hours	Holding other people accountable for their work. 4: 11-15 hours	Holding other people accountable for their work. 5: 16 or more hours
Assessing the performance of my team/office.	Assessing the performance of my team/office. 1: Never, 0 hours	Assessing the performance of my team/office. 2: 1-5 hours	Assessing the performance of my team/office. 3: 6-10 hours	Assessing the performance of my team/office. 4: 11-15 hours	Assessing the performance of my team/office. 5: 16 or more hours
Giving constructive feedback to others about their work performance.	Giving constructive feedback to others about their work performance. 1: Never, 0 hours	Giving constructive feedback to others about their work performance. 2: 1-5 hours	Giving constructive feedback to others about their work performance. 3: 6-10 hours	Giving constructive feedback to others about their work performance. 4: 11-15 hours	Giving constructive feedback to others about their work performance. 5: 16 or more hours
Contemplating leaving my job.	Contemplating leaving my job. 1: Never, 0 hours	Contemplating leaving my job. 2: 1-5 hours	Contemplating leaving my job. 3: 6-10 hours	Contemplating leaving my job. 4: 11-15 hours	Contemplating leaving my job. 5: 16 or more hours
Applying for other jobs elsewhere.	Applying for other jobs elsewhere. 1: Never, 0 hours	Applying for other jobs elsewhere. 2: 1-5 hours	Applying for other jobs elsewhere. 3: 6-10 hours	Applying for other jobs elsewhere. 4: 11-15 hours	Applying for other jobs elsewhere. 5: 16 or more hours