Allyship Self-Assessment Survey
Reflect on allyship through learning, listening, responding to bias, accepting feedback, and setting a practical 30-day growth commitment.
Every employee gets a seat — priced per employee in Communications & Intranet, quoted with this template ready.
Rolled out to every employee at AutoZone (125,000), PetSmart (50,000+), A.S. Watson and Raley's (20,000) — and at larger retailers we are not permitted to name.
Built for: Technology And Software · Higher Education · Healthcare · Financial Services · Nonprofit Organizations
Overview
The Allyship Self-Assessment Survey helps employees reflect on the behaviors that support inclusion and belonging at work. Its five core sections cover learning and awareness; listening and amplifying marginalized voices; responding to bias and exclusion; accepting feedback and practicing accountability; and commitment to ongoing growth. Each section combines five-point Likert statements with an open-ended prompt so respondents can explain what helps or gets in the way. The final Additional Reflection section provides space for context that does not fit elsewhere.
Use this template before an allyship workshop to establish reflection points, after training to identify behavior changes, or as part of an ERG or DEI development program. The 30-day commitment question turns general intentions into a concrete next step, while prompts about language, resources, and support can guide program design. Results are most useful when reviewed in aggregate alongside response rate and recurring themes.
This is not a knowledge test, a bias-detection instrument, or a substitute for investigating discrimination complaints. Do not use individual responses to label employees as good or bad allies, determine performance ratings, or pressure people to disclose identity or personal experiences. If the survey reveals a serious safety, harassment, or discrimination concern, route it through the organization’s established reporting and employee-relations process rather than treating the survey as the investigation channel.
Standards & compliance context
- Use an anonymity guarantee and data-minimization approach because responses may reveal sensitive views about identity, bias, exclusion, or psychological safety.
- For employees covered by GDPR or similar privacy laws, document the purpose and retention period, limit access, and provide the applicable notice and rights information through your privacy process.
- Do not use self-assessment results as standalone evidence in employment decisions, discrimination investigations, or disciplinary actions without review by qualified HR, employee-relations, and legal teams.
- Provide an established reporting route for disclosures of harassment, discrimination, retaliation, or immediate safety concerns instead of asking the survey to function as a complaint system.
General regulatory context for orientation only — verify current requirements with counsel or the relevant agency before relying on this template for compliance.
What's inside this template
Learning and Awareness
This section establishes whether employees are building the knowledge and context needed to recognize bias, inequity, and exclusion without relying on marginalized colleagues to provide unpaid education.
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I actively seek to understand how bias, inequity, and exclusion can affect people from different identities and backgrounds.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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I make time to learn from credible resources and lived experiences that broaden my understanding of inclusion and belonging.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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What would help you strengthen your learning about allyship or inclusion?
Optional follow-up. Consider responding if you selected Strongly disagree or Disagree to either learning statement.
Listening and Amplifying Marginalized Voices
This section focuses on everyday behaviors that make overlooked perspectives visible while preventing appropriation or the expectation that one person represents an entire community.
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I listen to people from marginalized or underrepresented groups without expecting them to educate me or represent an entire community.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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I create space for perspectives that may otherwise be overlooked in meetings, discussions, or decisions.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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When appropriate, I credit and amplify colleagues' ideas without taking ownership of their contributions.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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What makes it difficult for you to listen, create space, or amplify others' contributions?
Optional follow-up for responses rated Strongly disagree or Disagree.
Responding to Bias and Exclusion
This section examines whether employees can notice exclusion and choose a respectful, situation-appropriate action when workplace comments, decisions, or practices cause harm.
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I notice when workplace comments, decisions, or practices may create exclusion or disadvantage.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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When I observe bias or exclusion, I take a respectful action appropriate to the situation.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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I support inclusive practices even when doing so requires me to challenge assumptions or established habits.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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What support, language, or resources would help you respond to bias or exclusion more effectively?
Optional follow-up for responses rated Strongly disagree or Disagree.
Accepting Feedback and Practicing Accountability
This section measures the willingness to hear impact-focused feedback, avoid defensiveness about intent, and translate feedback into changed behavior.
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I remain open when someone explains that my words or actions had an unintended exclusionary impact.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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I listen to feedback without shifting the focus to defending my intent or personal discomfort.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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I take concrete steps to change my behavior after receiving constructive feedback about inclusion or allyship.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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What would help you receive feedback and turn it into meaningful action?
Optional follow-up for responses rated Strongly disagree or Disagree.
Commitment and Ongoing Growth
This section turns allyship from a label or one-time activity into an ongoing practice connected to psychological safety and a specific 30-day action.
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I understand that allyship is an ongoing practice rather than a one-time activity or label.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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I can identify at least one allyship behavior I want to practice more consistently.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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I feel able to practice allyship in my workplace in ways that support psychological safety and respect.
5-point scale: Strongly disagree, Disagree, Neither agree nor disagree, Agree, Strongly agree
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What is one specific allyship action you intend to practice in the next 30 days?
Optional personal commitment; avoid including names or confidential details.
Additional Reflection
This open space captures context, support needs, and concerns about allyship or inclusion that the structured questions do not anticipate.
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Anything else you would like to share about allyship, inclusion, psychological safety, or support needed in your workplace?
Please do not include confidential personal information or identify individual colleagues.
How to use this template
- Review each section and customize workplace examples while keeping the five-point Strongly disagree to Strongly agree scale and its neutral midpoint.
- Configure the survey as anonymous, remove unnecessary identifying fields, and explain the anonymity guarantee, purpose, audience, and expected completion time before sending it.
- Assign the survey to the defined employee audience after an allyship workshop, ERG activity, or inclusion initiative, and keep participation voluntary unless HR has approved another approach.
- Monitor response rate without identifying individuals, and close collection at the stated deadline so the results represent a defined program cohort rather than an open-ended stream.
- Analyze Likert patterns by section and code written responses for recurring barriers, support needs, psychological safety themes, and requested resources without exposing individual comments.
- Share aggregate findings, select a small number of actions, and invite respondents to revisit the specific allyship behavior they committed to practice in the next 30 days.
Best practices
- Use clear five-point Likert anchors from Strongly disagree to Strongly agree and retain a neutral midpoint rather than using raw numbers or an 11-point scale.
- Keep the survey focused on observable behaviors such as creating space, crediting ideas, responding to bias, and applying feedback instead of asking leading questions about whether the respondent is an ally.
- Preserve the open-ended follow-up after each behavior group so lower ratings can reveal the language, resources, or conditions employees need to act differently.
- Make anonymity the default and collect demographic questions only when there is a clear analytical purpose, placing them last and making them optional to reduce collection-bias concerns.
- Explain that the survey is for reflection and program improvement, not individual scoring, because a punitive frame can suppress candid responses and reduce the response rate.
- Keep a pulse version to one or two sections and reserve the full four-to-six-section format for annual engagement or program assessments to limit survey fatigue.
- Close the loop by publishing aggregate themes and naming owners and dates for follow-up actions, rather than collecting reflections without visible change.
- Keep the final Anything else? question so respondents can raise support needs or context that structured prompts miss.
What this template typically catches
Issues teams running this template most often surface in practice:
Common use cases
Frequently asked questions
What does the Allyship Self-Assessment Survey measure?
It measures self-reported allyship behaviors across five areas: learning and awareness, listening and amplifying marginalized voices, responding to bias and exclusion, accepting feedback, and ongoing growth. It also includes open-ended prompts about barriers, support, and a specific action for the next 30 days. It is designed for reflection and development, not for ranking employees.
Who should run this survey and who should receive it?
A DEI lead, People team, ERG program owner, or trained manager can administer it. It can be shared with employees participating in allyship training, ERG programming, inclusion initiatives, or leadership development. For candid responses, make participation voluntary and explain who can access results before launch.
How often should we use this self-assessment?
Use it at the start and end of an allyship program, or as an annual reflection tied to development planning. A short pulse version can revisit one or two sections quarterly without repeating the full survey. Avoid frequent administration that creates survey fatigue or turns personal reflection into a compliance exercise.
Should responses be anonymous?
Anonymity should be the default for this employee survey, especially when questions involve bias, exclusion, psychological safety, or feedback. Avoid collecting names, unnecessary demographics, or small-group identifiers that could make respondents recognizable. If follow-up is needed, offer a separate opt-in channel rather than attaching contact details to survey answers.
Can this survey be used for performance reviews or compliance reporting?
It is better suited to learning, reflection, and program evaluation than individual performance ratings or disciplinary decisions. Self-reported answers do not prove behavior and may be affected by social desirability or fear of consequences. Consult HR, employee relations, and legal advisors before linking responses to employment decisions or formal compliance records.
How should we customize the questions?
Keep the five-point Likert statements and their clear semantic anchors, such as Strongly disagree through Strongly agree, so results remain easy to interpret. Add examples relevant to your workplace, such as meeting practices, customer interactions, or decision-making forums. Keep demographic questions optional and last, and retain the final Anything else? prompt.
What should we do with low ratings or difficult written feedback?
Treat low ratings as signals for support and learning rather than evidence of individual failure. Review themes in aggregate, connect them to training or manager practices, and respond to recurring barriers with specific actions. Do not ask employees to identify colleagues or disclose sensitive experiences in a shared discussion.
How is this better than asking employees informally whether allyship is improving?
The template gives informal reflection a consistent structure across five behavior areas and combines ratings with open-ended explanations. That makes it easier to compare themes across program stages while preserving room for context. Ad-hoc conversations can still complement the survey, but they should not replace an anonymity guarantee or a documented action plan.
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Ready to use this template?
Every employee gets a seat. Request pricing for Communications & Intranet and we quote into a workspace with Allyship Self-Assessment Survey ready.
Rolled out to every employee at AutoZone (125,000), PetSmart (50,000+), A.S. Watson and Raley's (20,000) — and at larger retailers we are not permitted to name.