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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
worksafe.org
.
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* Indicates required question
Name
*
Your answer
Email or Social Media handle
*
Your answer
Cell Phone
*
Your answer
What Zip Code do you live in?
*
Your answer
What event were you at when you did this survey?
*
Choose
Through my Church
Outreach Event (i.e. Life is Living)
An outreach worker asked me to fill it out
Other
If an Outreach Event, then which one? [EVENT NAME, DATE i.e. Art & Soul, 9/17/23]
Your answer
What type of work do you do? (for example: Waitress, Cashier, Doctor, Pharmacist, Student, Unemployed, etc.)
*
Your answer
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.
Your answer
Are you interested in getting trained about workplace rights and issues?
*
Yes
No
Required
Are you interested attending a Black Legal Rights Clinic and meeting with an attorney about your workplace issues?
*
Yes
No
Required
Would you like receive more information about our project by being added to project newsletter?
*
Yes
No
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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