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.YesNo 2. If yes, were you working in Utah at the time?YesNo 3. What happened? 4. Did you discuss the incident(s) with a supervisor or someone in Human Resources?YesNoI don't recall 5. Please explain. 6. Do you feel like your supervisor or HR adequately addressed this situation?YesNo 7. Please explain. 8. How many employees did your employer have when this situation occurred?1-4 employees5-9 employees10-14 employees15 or more employees 9. Any additional comments about your experience?What is your age?Under 18 years old18-24 years old25-34 years old35-44 years old45-54 years old55-64 years old65-74 years old75 years or older What is your gender? What is your ethnicity?Asian / Pacific IslanderBlack or African AmericanHispanic or LatinoNative American or American IndianWhiteOther What is the highest level of school you have completed?Some high schoolHigh school graduate or GEDSome collegeTrade/technical/vocational trainingAssociate degreeBachelor’s degreeMaster’s degreeProfessional 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?YesNo Prev Next Submit