Listening Equity Project Survey

Thank you for participating in our Listening Equity Project Survey!

Many people rely on service providers in the community. You might talk to service providers at places like:
- Banks
- Community Centers
- First responders
- Libraries
- Healthcare offices
- Immigration services
- Pharmacies
- Police stations
- Museums
- Public transit
- Other people or places where you receive services
We know that sometimes talking with service providers is not always easy. We need your help to find out what they are getting wrong, so we can help them do better.

This survey takes about 5-6 minutes to complete and is roughly 25 questions long.

Thank you for helping us create more space to listen!

1) Do you have a disability or difference that affects how you communicate?*

yesno

10) Is there personal information you are asked for that is hard to say?*

My nameMy addressMy phone numberMy pin codeOther
Other (please specify here)

11) In the last year, have you had a challenging experience with a service provider, either calling or visiting in-person?*

Yes, just oneYes, multipleNo
As a reminder, you might talk to service providers at places like:
- Banks
- Community centers
- Healthcare offices
- Immigration services
- Libraries
- Museums
- Pharmacies
- Police stations
- Public transit

12) Did you visit or call during these experience(s)?*

Visited in-personCalled on phoneCalled with videoVisited and calledN/A

14) Which kinds of employees have you had difficulties with?*

Automated voice-activated systemsFront/desk receptionistsService professionals (ex. doctor, pharmacist, librarian, bank teller…)NoneOther
Other (please specify here)

15) If your visit was in-person, were there ways for you to communicate besides speaking/saying words?*

YesNoNot sure
(ex. pad and pen provided, ipad, touch-screen service)
If yes, what did they provide for non-speaking communication?

16) Did you experience any of the following issues during your visit or call?*

I was interrupted or talked overI was misunderstoodI had difficulties with an automated voice recognition systemI was laughed atOther
Other (please specify here)

17) Tell us about how the person you interacted with responded when your speech sounded different. If they did something unhelpful, what was it?
*Optional*
If they did something helpful, what was it?
*Optional*

18) How did you feel when the interaction(s) were finished?*

AnxiousAshamedFineFrustratedMadRelievedSadOther
Other (please specify here)

19) Were you hung up on or denied service because of your communication disability or difference?*

NoYes, I had to call back/return to the service providerYes, they contacted me afterwards to resolve the issueYes, and I gave upNot sure

20) Have your experiences impacted your willingness to visit a service provider again?*

Yes, it stressed me out and makes me worried about future calls/visitsYes, I feel more confident now for next timeNo, it didn’t make any differenceNot sure

21) What are your concerns, if any, about making a call or visiting a service provider in the future?*

I worry they will judge meI worry they will laugh at meI worry they will interrupt meI worry they will rush meIf I call, I worry they will hang upI don’t have any major concernsOther
Other (please specify here)

22) Can we contact you directly to find out more about what you’ve shared with us in this survey?*

YesNo
23) We’re putting together a mailing list of people interested in getting more involved in this campaign. This might be giving feedback, filling in polling or volunteering. Would you be interested in joining?*

YesNo
24) What is your email address, so we can get in touch?*
example@example.com

Thank you for your input! Please click submit to make sure your survey responses are recorded.
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