Worker Survey

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Worker Survey

Thank you for taking the time to fill out our survey. We would love to learn more about you and your work experience. Worksafe is seeking Black workers to learn about their rights and serve as community leaders about workers rights. To learn more about our project, visit blackworkerinitiative.com.

Name *

Email or Social Media handle *

Cell Phone *

What Zip Code do you live in? *

What event were you at when you did this survey? *

If an Outreach Event, then which one? [EVENT NAME, DATE i.e. Art & Soul, 9/17/23]

What type of work do you do? (for example: Waitress, Cashier, Doctor, Pharmacist, Student, Unemployed, etc.) *

Have you experienced any of the following workplace issues (check all that apply): *

Wage Theft (didn't pay me, check amount wasn't right, paid less than min wage, etc))

Health or Safety (something wasn't safe at work, I got hurt or sick, etc.)

Racial discrimination (treated differently because of my race or ethnicity, etc.)

Gender discrimination (treated differently because of my gender, sexual orientation, etc.)

Sexual harassment (unwelcome sexual advances, requests for sexual favors, verbal/physical harassment of a sexual nature)

Harassment (unwelcome &/or repeated words/actions that are known/should be known to be offensive, embarrassing, humiliating/demeaning to a worker or workers, etc.)

None

Other

Required

If you said "Other," please explain.

Are you interested in getting trained about workplace rights and issues? *

Yes

Required

Are you interested attending a Black Legal Rights Clinic and meeting with an attorney about your workplace issues? *

Yes

Required

Would you like receive more information about our project by being added to project newsletter? *

Yes

Required

If you marked "Yes," to any of the questions above, please make sure you have entered your contact information above.

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