Equity, Diversity, and Inclusion
Department of Surgery Survey, September 2020
Q1a. I believe my colleagues treat me fairly regardless of my gender/gender identity, race/ethnicity, age, sexual orientation, family status, language, religion, or disability.
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Strongly agree
Agree
Disagree
Strongly disagree
b) Compared to my peers, I have perceived salary inequity that may be affected by gender/gender identity, race/ethnicity, age, sexual orientation, family status, language, religion, or disability.
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Strongly agree
Agree
Disagree
Strongly disagree
c. Overall, I feel accepted in my workplace environment(s) regardless of my gender/gender identity, race/ethnicity, age, sexual orientation, family status, language, religion, or disability.
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Strongly agree
Agree
Disagree
Strongly disagree
d) I believe that those in leadership positions (e.g. Chief of Surgery/Anaesthesia/Nursing, Departmental Chair of Surgery, Division Chairs, Hospital Division Heads) are committed to advancing equitable work environments.
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Strongly agree
Agree
Disagree
Strongly disagree
e) I believe that leadership fairly and uniformly applies standards of professionalism to myself and/or my colleagues regardless of gender/gender identity, race/ethnicity, age, sexual orientation, family status, language, religion, or disability.
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Strongly agree
Agree
Disagree
Strongly disagree
f) I believe that my access to education, training, and other professional opportunities is not affected by my gender/gender identity, race/ethnicity, age, sexual orientation, family status, language, religion, or disability.
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Strongly agree
Agree
Disagree
Strongly disagree
g) I believe that my ability to achieve successful outcomes, including promotion, is not affected by my gender/gender identity, race/ethnicity, age, sexual orientation, family status, language, religion, or disability.
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Strongly agree
Agree
Disagree
Strongly disagree
h) I believe that my ability to influence workplace decision-making is not affected by my gender/gender identity, race/ethnicity, age, sexual orientation, family status, language, religion, or disability.
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Strongly agree
Agree
Disagree
Strongly disagree
i) I know how to seek accommodation if my gender/gender identity, race/ethnicity, age, sexual orientation, family status, language, religion, or sex (including pregnancy) prevents or hinders my clinical or academic participation.
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Strongly agree
Agree
Disagree
Strongly disagree
j) I am aware of my rights and responsibilities within my workplace environment(s) in order to ensure a respectful, accessible and safe workplace environment.
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Strongly agree
Agree
Disagree
Strongly disagree
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Next
Q2. What language(s) do you speak? Check all that apply. (NOTE: For ease, languages are arranged alphabetically)
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American Sign Language
Amharic
Arabic
Bengali
Cantonese
Czech
Dari
English
Farsi
French
Greek
Hebrew
Hindi
Hungarian
Italian
Japanese
Karen
Korean
Mandarin
Nepali
Polish
Portuguese
Punjabi
Russian
Serbian
Slovak
Somali
Spanish
Tagalog
Tamil
Tigrinya
Turkish
Twi
Ukrainian
Urdu
Vietnamese
Other
Other
If other, please specify:
Q3. What is your age?
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30-39
40-49
50-59
60-69
70+
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Q4a. Persons with disabilities are currently defined those with long-term or recurring physical, mental, sensory, psychiatric, or learning impairments. Based on this definition, do you currently identify as living with a disability?
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Yes
No
Prefer not to answer
b. If you responded Yes to 4a, which type(s) of disability(ies) do you currently have? Check all that apply.
Addiction to alcohol or drugs
Chronic illness (e.g. epilepsy, cystic fibrosis, cancer, diabetes)
Developmental disability (e.g. autism, down syndrome, brain injury)
Learning disability (e.g. dyslexia, ADHD)
Mental illness (e.g. schizophrenia, depression)
Physical disability (e.g. cerebral palsy, spinal cord injury, amputation)
Sensory disability (e.g. hearing loss, vision loss)
Prefer not to answer
Other
Other, please specify:
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Q5. Which of the following best describes your racial or ethnic identity? Check all that apply.
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Aboriginal
Asian (Chinese, Filipino, East Asian, South Asian, Korean, Japanese, Vietnamese, etc)
Black (African American, Haitian, Jamaican, Nigerian, Ethiopian, etc)
Hispanic, Latino, or Spanish (Argentinian, Brazilian, Mexican, Colombian, Cuban, Dominican, Ecuadorian, El Salvadorian, Portuguese, Venezuelan, etc)
Middle Eastern or North African (Algerian, Egyptian, Iranian, Israeli, Jordanian, Lebanese, Moroccan, Syrian, etc)
White, European (British, German, Irish, Italian, Polish, Scottish, etc)
Native Hawaiian or Other Pacific Islander
Mixed Race
Prefer not to answer
Other
Other, please specify:
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Q6. Which of the following best describes your current religious and/or spiritual affiliation?
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Agnosticism
Animism or Shamanism
Atheism
Baha'i Faith
Buddhism
Christian
Confucianism
Hinduism
Islam
Jainism
Judaism
Native Spirituality
Pagan
Rastafarianism
Sikhism
Spiritual
Unitarianism
Zoroastrianism
I don't identify with a religious or spiritual affiliation
Prefer not to answer
Other
Other, please specify:
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Q7. Which of the following best describes your current gender identity? Check all that apply.
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Female
Male
Transgendered
Intersex
Gender fluid
Gender non-conforming
Non-binary
Two-spirit
Prefer not to answer
Other
Other, please specify:
Q8. Which of the following best describes your current sexual orientation? Check all that apply.
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Bisexual
Gay
Heterosexual
Lesbian
Queer
Questioning
Asexual
Pansexual
Prefer not to say
Other
Other, please specify:
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Q9. Would you be willing to complete this survey every 3 years?
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Yes
No
Q10. Are there any other categories that you would like to see included in future surveys?
Q11. How could we improve this survey for you?
Q12. Do you have any other feedback for us regarding the measurement of demographics and EDI at the Department of Surgery?
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