Workplace Discrimination

1. Have you ever felt discriminated against at work because of your race, national origin, religion, sex (including pregnancy, childbirth, or breastfeeding), sexual orientation, disability, or age?

Discrimination based on sex includes experiences of sexual harassment.

Yes

2. If yes, were you working in Utah at the time?

Yes

3. What happened?

4. Did you discuss the incident(s) with a supervisor or someone in Human Resources?

Yes

I don't recall

5. Please explain.

6. Do you feel like your supervisor or HR adequately addressed this situation?

Yes

7. Please explain.

8. How many employees did your employer have when this situation occurred?

1-4 employees

5-9 employees

10-14 employees

15 or more employees

9. Any additional comments about your experience?

What is your age?

Under 18 years old

18-24 years old

25-34 years old

35-44 years old

45-54 years old

55-64 years old

65-74 years old

75 years or older

What is your gender?

What is your ethnicity?

Asian / Pacific Islander

Black or African American

Hispanic or Latino

Native American or American Indian

White

Other

What is the highest level of school you have completed?

Some high school

High school graduate or GED

Some college

Trade/technical/vocational training

Associate degree

Bachelor’s degree

Master’s degree

Professional or doctorate degree

In what industry did you work when this experience occurred?

In what city is/was this employer located?

Your name (CONFIDENTIAL)

Your phone number (CONFIDENTIAL)

Your email (CONFIDENTIAL)

In what House and Senate district do you live?

Not sure? Find out here: http://le.utah.gov/GIS/findDistrict.jsp

Would you be willing to speak with us regarding your experience?

Yes