Template to help you monitor equality and diversity in your organisation. Free to download and use.
You can use this form to:
- monitor diversity of job applicants, by including it with your job application forms when recruiting
- monitor the diversity of your workforce
This is a general purpose form. You can adapt it to suit your organisation's needs. If you use this template, make sure you comply with data protection law (GDPR). Go to GOV.UK to check what personal data employers can keep.
To avoid discrimination when recruiting:
- you must keep the information on this form separate from the application form and CV
- anyone involved in interviewing or deciding who to hire must not have access to the information
- you should not ask applicants to enter their name or any other information that identifies who they are
Find out more about following discrimination law in recruitment
Documents
Equality and diversity monitoring form template (Word version, 31KB)
Equality and diversity monitoring form template (OpenDocument Text format, 17KB)
If you need the template in a different format, email digital@acas.org.uk
You can also copy and paste the following template text.
Template text – equality and diversity monitoring form
[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:
- Prefer not to say
Black, African, Caribbean or Black British
- African
- Black British
- Caribbean
- Another Black, African or Caribbean background, please say what:
- 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:
- Prefer not to say
White
- English
- Gypsy or Irish Traveller
- Irish
- Northern Irish
- Scottish
- Welsh
- Other European
- Another White background, please say what:
- Prefer not to say
Another ethnic group
- Arab
- Another ethnic group, please say what:
- 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:
- Prefer not to say
Sex
What is your sex?
- Female
- Male
- Prefer to self describe, please say how:
- Prefer not to say
Gender reassignment
Is the gender you identify with the same as your sex recorded at birth?
- Yes
- No
- Prefer not to say
Sexual orientation
What is your sexual orientation?
- Asexual
- Bisexual
- Gay
- Heterosexual
- Lesbian
- Pansexual
- Questioning
- Prefer to self describe, please say how:
- Prefer not to say