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Equality and Diversity Monitoring Form Template Nov 2023

This document is a sample equality and diversity monitoring form that organizations can adapt to collect optional information from employees. It collects information about employees' gender, age, ethnicity, disability status, sexual orientation, religion, work arrangements, and caring responsibilities. The organization wants this information to help meet its equality goals and commitments, but providing the information is voluntary. Any data collected will be kept confidential and used only for monitoring purposes.

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Benjamin Joseph Ndhlovu
Copyright
© © All Rights Reserved
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Download as ODT, PDF, TXT or read online on Scribd
22 views

Equality and Diversity Monitoring Form Template Nov 2023

This document is a sample equality and diversity monitoring form that organizations can adapt to collect optional information from employees. It collects information about employees' gender, age, ethnicity, disability status, sexual orientation, religion, work arrangements, and caring responsibilities. The organization wants this information to help meet its equality goals and commitments, but providing the information is voluntary. Any data collected will be kept confidential and used only for monitoring purposes.

Uploaded by

Benjamin Joseph Ndhlovu
Copyright
© © All Rights Reserved
Available Formats
Download as ODT, PDF, TXT or read online on Scribd
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Example of equality and diversity monitoring form

This is a sample form that you can adapt or develop to meet your needs. Make
sure you adapt this template to comply with the UK General Data Protection
Regulation (UK GDPR). If you need help with this go to www.ico.org.uk.

[Add your organisation’s name] wants to meet the aims and commitments set
out in its equality policy. This includes not discriminating under the Equality Act
2010, and building an accurate picture of the make-up of the workforce in
encouraging equality and diversity.

The organisation needs your help and co-operation to enable it to do this, but
filling in this form is voluntary. The information provided will be kept
confidential and will be used for monitoring purposes.

If you have any questions about the form contact [add contact details].

Please return the completed form to [add details].

Sex and gender identity

What is your sex?


Female  Male  Prefer not to say 
Is the gender you identify with the same as your sex registered at birth?
Yes ☐ No ☐ Prefer not to say ☐

If the gender you identify with is not the same as your sex registered at birth, please
write in:

Age 16-24  25-29  30-34  35-39  40-44  45-49 


50-54  55-59  60-64  65+  Prefer not to say 
What is your ethnicity?
Ethnic origin is not about nationality, place of birth or citizenship. It is about the group
to which you perceive you belong. Please tick the appropriate box

Asian or Asian British


Indian  Pakistani  Bangladeshi  Chinese  Prefer not to say 
Any other Asian background, please write in:

Black, African, Caribbean or Black British


African  Caribbean  Prefer not to say 
Any other Black, African or Caribbean background, please write in:

Mixed or Multiple ethnic groups


White and Black Caribbean  White and Black African  White and Asian 
Prefer not to say  Any other Mixed or Multiple ethnic background, please write in:

White
English  Welsh  Scottish  Northern Irish  Irish 
British  Gypsy or Irish Traveller  Prefer not to say 
Any other White background, please write in:

Other ethnic group


Arab  Prefer not to say  Any other ethnic group, please write in:

Do you consider yourself to have a disability or health condition?


Yes  No  Prefer not to say 
What is the effect or impact of your disability or health condition on your work? Please
write in here:

The information in this form is for monitoring purposes only. If you believe you need a
‘reasonable adjustment’, then please discuss this with your manager, or the manager
running the recruitment process if you are a job applicant.

What is your sexual orientation?


Heterosexual  Gay  Lesbian  Bisexual  Asexual 
Pansexual 
Undecided 
Prefer not to say 
If you prefer to use your own identity, please write in:

What is your religion or belief?


No religion or belief  Buddhist  Christian  Hindu  Jewish 
Muslim 
Sikh  Prefer not to say  If other religion or belief, please write in:
What is your working pattern?

Full-time  Part-time  Prefer not to say 


What is your flexible working arrangement?
None  Flexi-time  Staggered hours  Term-time hours 
Annualised hours  Job-share  Flexible shifts  Compressed hours 
Homeworking  Prefer not to say  If other, please write in:

Do you have caring responsibilities? If yes, please tick all that apply

None 
Primary carer of a child/children (under 18) 
Primary carer of disabled child/children 
Primary carer of disabled adult (18 and over) 
Primary carer of older person 
Secondary carer (another person carries out the main caring role) 
Prefer not to say 

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