Equality and Diversity Monitoring Form by Acas
This template is an Equality and Diversity Monitoring Form designed for organisations to collect demographic data from their job applicants or workforce. It aims to help organisations meet their equality policy commitments and understand the diversity within their ranks, in line with the Equality Act 2010. Completion is voluntary, and the information collected is confidential and used solely for monitoring purposes.
Equality and Diversity Monitoring Form (Template)
[Name of your organisation] wants to meet the aims and commitments set out in our equality policy. This includes not discriminating under the Equality Act 2010.
Please complete this form to help us understand the diversity of our [job applicants/workforce].
Completing this form is voluntary. The information provided will be kept confidential. The information is going to be used to help us understand the diversity of our organisation.
[Include for job applicants] None of the information you provide will be linked to your application.
If you have any questions about the form contact [contact details].
Please return the completed form to [email address].
Age
What is your age?
[ ] 19 or under
[ ] 20 to 29
[ ] 30 to 39
[ ] 40 to 49
[ ] 50 to 59
[ ] 60 to 69
[ ] 70+
[ ] Prefer not to say
Disability
Do you have a disability, impairment or health condition which affects your day-to-day activities?
[ ] Yes
[ ] No
[ ] Prefer not to say
The information in this form is for monitoring purposes only. If you believe you need a reasonable adjustment, then please discuss this with [your manager/ the manager running the recruitment process].
Ethnicity
What is your ethnicity?
This may be different to your nationality, place of birth or citizenship.
Asian or Asian British
[ ] Asian British
[ ] Bangladeshi
[ ] Chinese
[ ] Indian
[ ] Pakistani
[ ] Another Asian background, please say what or tap here to enter text.
[ ] Prefer not to say
Black, African, Caribbean or Black British
[ ] African
[ ] Black British
[ ] Caribbean
[ ] Another Black, African or Caribbean background, please say what or tap here to enter text.
[ ] Prefer not to say
Mixed or Multiple ethnic groups
[ ] Asian and White
[ ] Black African and White
[ ] Black Caribbean and White
[ ] Another Mixed or Multiple ethnic group, please say what or tap here to enter text.
[ ] Prefer not to say
White
[ ] English
[ ] Gypsy or Irish Traveller
[ ] Irish
[ ] Northern Irish
[ ] Scottish
[ ] Welsh
[ ] Other European
[ ] Another White background, please say what or tap here to enter text.
[ ] Prefer not to say
Another ethnic group
[ ] Arab
[ ] Another ethnic group, please say what or tap here to enter text.
[ ] Prefer not to say
Religion or belief
What is your religion or belief?
[ ] No religion or belief
[ ] Buddhist
[ ] Christian
[ ] Hindu
[ ] Jewish
[ ] Muslim
[ ] Sikh
[ ] Another religion or belief, please say which or tap here to enter text.
[ ] Prefer not to say
Sex
What is your sex?
[ ] Female
[ ] Male
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