EVS Discrimination Survey Question Title * 1. Contact Information Name Job Title/Classification Email Address Cell Phone Number Question Title * 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: Question Title * 3. Have you been assigned to COVID discharge? Yes No Question Title * 4. If you answered yes to the question above, how many times? Question Title * 5. Have you ever been disciplined at work? Yes No Question Title * 6. Have you witnessed your coworkers being disciplined? Yes No Question Title * 7. Have you been bullied or harassed by management in your time working in EVS? Yes No Question Title * 8. If you answered yes to the question above, can you please provide a description of what happened including details about who, when, and where the incident occurred? Question Title * 9. Have you experienced racism while working at SFGH? Yes No Question Title * 10. If yes, can you provide more detail about what happened? Question Title * 11. Do you believe that the EVS department is bullying or harassing SEIU 1021 members based on their race? Yes No Done
