The Pharmaceutical Society NI, in adopting the principles of good regulatory practise is undertaking equality monitoring of the register of pharmacists in Northern Ireland. This form has been developed using guidance provided for public authorities by the Equality Commission of Northern Ireland in relation to Section 75 of the Northern Ireland Act 1998. The organisation is not listed as a public authority but is viewed by government as an organisation resembling a public body. This monitoring is undertaken in order to highlight possible inequalities in the register and to ascertain why they occur. Completing this form is voluntary.

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* 1. What is your age?

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* 2. What is your gender?

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* 3. What is you marital or civil partnership status?

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* 4. Do you consider yourself disabled as set out by the Disability Discrimination Act?

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* 5. Do you have personal responsibility for the care of any dependents?

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* 6. To which of these ethnic groups do you consider you belong?

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* 7. What religion, religious denomination or body do you belong to?

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* 8. My sexual orientation is towards someone:

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* 9. Do you consider yourself to be part of:

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