Equal Opportunities Monitoring

Equal Opportunities

What is your sex?
1. Male
2. Female
3. Inter-sex
What is your age?
1. Under 16
2. 16 - 17
3. 18 - 19
4. 20 - 24
5. 25 - 34
6. 35 - 44
7. 45 - 54
8. 55 - 64
9. 65 - 74
10. 75 and over
Disability
Do you have any physical or mental health conditions, illnesses or impairments, lasting, or expected to last, 12 months or more?
1. Yes
2. No
3. Don't know
Does your condition, illness or impairment reduce your ability to carry out day-to-day activities?
1. Yes - a lot
2. Yes - a little
3. Not at all
Do you have any health conditions, illnesses or impairments which affect you in the following areas? Please choose ALL that apply;
1. Vision (for example blindness or partial sight)
2. Hearing (for example deafness or partial hearing)
3. Mobility (for example walking short distances or climbing stairs)
4. Dexterity (for example, lifting and carrying objects or using a keyboard)
5. Learning or understanding / concentrating (for example associated with Dyslexia or Down’s syndrome)
6. Memory
7. Mental Health
8. Stamina or breathing or fatigue
9. Socially or behaviourally (for example, associated with autism, attention deficit disorder or Asperger’s syndrome)
10. Other
If other - Please describe
Pregnancy & Maternity
Are you pregnant, or have you given birth within the past 26 weeks?
1. No
2. Yes - I’m pregnant
3. Yes - I’ve given birth within the past 26 weeks
Language
What is your main language?
1. English
2. Welsh
3. Other
If Other - Please specify
Can you understand, speak, read or write Welsh? - Please choose ALL that apply
1. Understand Spoken Welsh
2. Speak Welsh
3. Read Welsh
4. Write Welsh
5. None of the above
National Identity
How would you describe your national identity? Please choose ALL that apply.
1. Welsh
2. English
3. Scottish
4. Northern Irish
5. British
6. Irish
7. Polish
8. Other
If other - Please describe
Ethnicity
White
1. Welsh / English / Scottish / British / Northern Irish
2. Irish
3. Gypsy or Irish Traveller
4. Any other White background
If other - please describe
Mixed/Multiple ethnic groups
1. White and Black Caribbean
2. White and Black African
3. White and Asian
4. Any other Mixed / Multiple ethnic background
If other - please describe
Asian/Asian British
1. Indian
2. Pakistani
3. Bangladeshi
4. Chinese
5. Any other Asian background
If other - please describe
Black / African / Caribbean / British
1. African
2. Caribbean
3. Any other Black / African / Caribbean background
If other - please describe
Other Ethnic group
1. Arab
2. Any other ethnic group
If other - please describe
Sexual Identity
Which of the following best describes how you think of yourself?
1. Heterosexual or Straight
2. Gay or Lesbian
3. Bisexual
4. Other
5. Prefer not to say
Marital or Same-sex Civil Partnership Status
What is your current marital or same-sex civil partnership status?
1. Single (that is; never married and never registered in a same-sex Civil Partnership)
2. Married
3. In a registered same-sex Civil Partnership
4. Other
If other - Please describe

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Disability

Pregnancy & Maternity

Language

National Identity

Ethnicity

Sexual Identity

Marital or Same-sex Civil Partnership Status