Example of a Self-Identification Survey employment equity

Example of a Self-Identification Survey

Warning

Information collected from this survey is confidential and will only be used by, or be disclosed for, carrying out the organization's obligations under the Employment Equity Act. With your consent, it may also be used for human resources management purposes related to employment equity. This includes referrals for training and developmental assignments, as well as the establishment of special programs.
Completion of the employee identification section is mandatory, as is the return of the survey.
Completing the self-identification section of the survey is voluntary.
An employee may be a member of more than one designated group and may update their information at any time.
Identifying a disability in this survey does not constitute a request for accommodation, which should be made in accordance with the accommodation policy.

Survey contains two types of questions

Questions we, the employer, are required to ask you, the employee, pursuant to the Employment Equity Act,
Questions that we are asking because we believe they are relevant to promoting diversity and inclusion even though they are not required by the Employment Equity Act.

Example

(Mandatory) Employee Identification

Family Name
Given name
Employee ID

This section is a (Voluntary) Self-identification

Are you a person with a disability?^{Footnote 1}

Yes
No
Prefer not to say

This information is not required by the Employment Equity Act (Optional) Additional detail about your disability/disabilities, select all that apply:

Hearing
Seeing
Mobility
Flexibility
Dexterity
Pain
Learning
Memory
Developmental
Mental and/or psychological
Unknown disability type
Prefer not to say
Other

Are you an Indigenous person?^{Footnote 2}

Yes
No
Prefer not to say

This information is not required by the Employment Equity Act (Optional) If yes, are you:

First Nations
Inuk (Inuit)
Métis
Prefer not to say

Are you a racialized person?^{Footnote 3}

Yes
No
Prefer not to say

This information is not required by the Employment Equity Act (Optional) If yes, are you:

South Asian (e.g., East Indian, Pakistani, Sri Lankan, Indo-Caribbean etc.)
Chinese
Black
Filipino
Latin American
Arab
Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai, etc.)
West Asian (e.g., Iranian, Afghan, etc.)
Korean
Japanese
Mixed race
Other (please specify)

(Mandatory) Do you agree that this information may be used for human resources management purposes related to employment equity?

Footnotes

Footnote 1

Persons with disabilities are those that have a long-term or recurring physical, mental, sensory, psychiatric or learning impairment and who (a) consider themselves to be disadvantaged in employment by reason of that impairment, or (b) believe that an employer or potential employer is likely to consider them to be disadvantaged in employment by reason of that impairment. This also includes persons whose functional limitations owing to their impairment have been accommodated in their current job or workplace.

Return to footnote 1 referrer

Footnote 2

For the purposes of the Employee Equity Act an Indigenous person includes anyone who identifies as First Nations (North American Indian), Métis and/or Inuk (Inuit), and/or those who report being Registered or Treaty Indians (that is, registered under the Indian Act of Canada), and/or those who have membership in a First Nation or Indian band.

Return to footnote 2 referrer

Footnote 3

For the purposes of the Employee Equity Act racialized persons are persons, other than Aboriginal peoples, who are non-Caucasian in race or non-white in color, regardless of birthplace.

Return to footnote 3 referrer

Example of a Self-Identification Survey employment equity