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* 1. Please tell us your full name. 

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* 2. What is the name of your organisation.

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* 3. Please tell us your job title.

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* 4. Please tell us your email address.

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* 5. Which age category best applies to you?

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* 6. Which gender best applies to you?

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* 7. Which ethnicity best applies to you?

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* 8. Which region do you live in?

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* 9. I understand what racial (micro)aggressions are.

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* 10. Black, Asian and Minority Ethnic staff experience racial discrimination and racial (micro)aggression within our organisation.

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* 11. I know my employer's complaints process and I feel safe following it.

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* 12. I am more comfortable discussing cultural similarities than discussing difference.

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* 13. I believe I have power and privilege within the organisation that I can use to improve racial equity and inclusion.

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* 14. Our organisation facilitates regular, open and honest dialogue about the impact of racism on their staff, service users and clients.

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* 15. My performance appraisal is linked to good equalities behaviours.

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* 16. I feel safe to bring my whole self to work.

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* 17. I am comfortable calling in racial bias and banter when I am in the workplace.

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* 18. I would like to receive email updates from Mabadiliko CIC about upcoming events and information

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