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Inclusion and belonging survey template

Learn whether everyone feels they belong, and what would make it better

Three questions on belonging, being yourself at work, fair decisions, whether people like them can succeed and how comfortable they are speaking up. Use it as it is or change any question, and Usertick reads every written answer for you.

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What this inclusion and belonging survey tells you

An inclusion and belonging survey asks employees whether they feel part of the company and treated fairly in it. This template asks three questions in about a minute: four statements on belonging, being yourself, fair decisions and the chance to succeed, how comfortable people are speaking up in meetings, and what would make the workplace more inclusive.

It is written for a link shared once or twice a year, with Anonymous responses turned on. Share it by link or QR code: Usertick then stores no user ID, traits or visitor ID with the answers, and keeps the country and a salted hash of the IP address. A survey sent through Usertick email ties each answer to the person's contact, so keep email for other surveys. The chat layout asks the same questions one at a time.

Every written answer is read as it arrives, in any language, and filed under a category from your list, such as team and culture or managers and leadership, with a type and an urgency. Results shows a heat map of the four statements and the average comfort score, each compared with the round before.

In an emailAs a linkOn your websiteAs a conversation
Questions
3
Time to answer
About a minute
Written for
A link shared once or twice a year, with Anonymous responses on
Plans
Every plan, the free plan included

See it on every channel

The same template on your website, behind a link, in an email and as a conversation.

In an email

Send it from Usertick to a contact list, and a button in the email opens the survey on its own page. Usertick sends 50 emails a month on the free plan, or connect your own sender.

The 3 questions, one by one

What each question asks, why it is there, what it shows you and what to change.

Question 1 of 3 · Matrix · Optional

How much do you agree with these statements?

Why ask it
Four statements cover the core of inclusion: belonging, being yourself, fair decisions and a real chance to succeed.
What you learn
A heat map per statement with its average, so a gap between I feel I belong here and Decisions here are made fairly shows where to start.
Make it yours
Keep the statements the same every round, so Results compares each one with the period before.
Question 2 of 3 · Big scale

How comfortable are you speaking up in meetings?

Why ask it
Speaking up in meetings is where inclusion shows day to day, and a 1 to 10 scale picks up small changes between rounds.
What you learn
The average on the 1 to 10 scale and a column per step, so a group at the low end stays visible behind a good average.
Make it yours
Select the low steps in Results to read what those people wrote about a more inclusive workplace.
Question 3 of 3 · Text · Optional

What would make this a more inclusive place to work?

Why ask it
The open question asks for changes, which gives you actions to take along with the scores.
What you learn
Usertick reads each answer, files it under a category and a theme such as team and culture or managers and leadership, marks ideas and complaints, and flags the urgent ones.
Make it yours
Share the themes with the whole company, and handle any answer about harassment as a case for HR outside the survey.

What the answers show

Results turns each question into numbers you can follow week by week.

How much do you agree with these statements?

Each row's answers side by side, so the part that needs work stands out.

Every written answer, read for you

Each answer arrives with its category, theme, type and urgency, so the urgent ones reach your team first.

Use this template in four steps

From the template to the first answers.

  1. 1

    Open the template

    Sign up free and pick Belonging and inclusion in the template gallery. It opens in a matching style, ready to change.

  2. 2

    Make the questions yours

    Reword any question, change the options, and add logic or more questions.

  3. 3

    Choose where it runs

    Show it on your website, send it by email, share its link and QR code, or switch it to a conversation.

  4. 4

    Publish and read the answers

    Answers arrive in Results and the inbox as people send them, each written one read and filed by Usertick.

Tips for this survey

Small choices that keep people answering and the answers useful.

  1. 01

    Turn on Anonymous responses

    Templates come with it off. Turn it on before you share the link or QR code, and tell people what is stored and what isn't.

  2. 02

    Be careful with group questions

    If you add questions about background or identity, keep them optional and broad. In a small company, a narrow group can point to one person.

  3. 03

    Leave out health questions

    Usertick's terms don't allow health records or medical details, so don't ask about health conditions in this survey.

  4. 04

    Report back within a month

    Share the main themes and one or two actions within a month of closing, so people see what their answers changed before the next round.

Churn surveysEmail surveysBelonging and inclusion questions

More retention templates and questions

Templates like this one, and single questions from the library to add to it.

Templates

Browse all templates
RetentionTeam pulseA short, anonymous check on workload, support and whether people feel heard. Send it every week or two to the whole team.
RetentionRemote work checkCheck how remote work is going for your team: focus time, connection and what gets in the way. Send it once a quarter, anonymously.
RetentionManager feedbackGive team members an anonymous way to rate their manager on clarity, feedback and support. Run it twice a year, before development conversations.
RetentionBenefits satisfactionLearn how satisfied employees are with their benefits, which ones they value, which go unused and how yours compare with other employers. Send it before open enrollment or budget planning.

Questions from the library

Browse the question library
  1. How much do you feel you belong on your team?Big scale · Belonging and inclusion
  2. How much do you agree about working here?Matrix · Belonging and inclusion
  3. Do you feel comfortable speaking up in meetings?Yes / No · Belonging and inclusion
  4. How was your week?Mood dial · Team pulse
  5. How manageable was your workload?Big scale · Team pulse
  6. Did you have what you needed to do your job?Yes / No · Team pulse

Frequently asked questions

Once or twice a year. Keep the questions the same, so each round is compared with the one before, and leave enough time between rounds to act on what you heard.

With Anonymous responses on and the survey shared by link or QR code, Usertick stores no user ID, traits or visitor ID with the answers, and keeps the country and a salted hash of the IP address. A written answer can still contain details that point to the writer.

Yes, by adding a question that names the group, such as the team, and selecting an answer in Results. Keep groups broad, since Usertick has no minimum group size for showing results.

Read the written answers from the people who gave low comfort scores, choose one statement to work on, and tell the company what will change before the next round.

Usertick can send it to a contact list, but each answer then stays tied to the contact, even with Anonymous responses on. Paste the link into your own email or team chat instead.

Yes. Every template comes with every plan, the free plan included, and the free plan covers 150 responses a month across your surveys.

Yes. The template becomes your own survey, so reword any question, add or remove questions, and change the options and the logic. The gallery stays as it is.

Yes, from Starter. The template is written in US English. Add languages by hand or with AI translation, and each person sees the survey in their browser's language.

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