Survey Series on Accessibility - Experiences with Accessibility and Employment
For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Respondent confirmation (RC)
- Difficulties and long-term conditions (LTC)
- Main activity (MA)
- Difficulties related to accessibility and employment (DAE)
Respondent confirmation (RC)
Respondent confirmation (RC) - Question identifier:RC_R01
The following questions are for [NAME OR EMAIL].
Difficulties and long-term conditions (LTC)
Difficulties and long-term conditions (LTC) - Question identifier:LTC_R05
The following questions are about difficulties or long-term conditions you may have. Only difficulties or long-term conditions that have lasted or are expected to last for six months or more should be considered.
Difficulties and long-term conditions (LTC) - Question identifier:LTC_Q05
Do you have any of the following difficulties or long-term conditions?
Do you have:
- 1: Difficulty seeing even when wearing glasses or contact lenses
- 2: Difficulty hearing even when using a hearing aid or cochlear implant
- 3: Difficulty walking, using stairs, using your hands or fingers, or doing other physical activities
- 4: Difficulty learning, remembering or concentrating
- 5: Any emotional, psychological or mental health conditions (e.g., anxiety, depression, bipolar disorder, substance abuse, anorexia)
- 6: Any other health problem or long-term condition that has lasted or is expected to last for six or more months
- 7: I do not have any difficulty or long-term condition that has lasted or is expected to last for six or more months
Difficulties and long-term conditions (LTC) - Question identifier:LTC_R10
The next questions deal with the impact of your [conditions/condition] on your daily activities. Consider the impact of all difficulties or long-term conditions that you have.
Difficulties and long-term conditions (LTC) - Question identifier:LTC_Q10
How often [do your conditions/does your condition] limit your daily activities?
Would you say:
- 1: Never
- 2: Rarely
- 3: Sometimes
- 4: Often
- 5: Always
- 6: Don't know
Difficulties and long-term conditions (LTC) - Question identifier:LTC_Q15
How much difficulty do you have with daily activities because of your [conditions/condition]?
Would you say:
- 1: No difficulty
- 2: Some difficulty
- 3: A lot of difficulty
- 4: You cannot do most activities
- 5: Don't know
Main activity (MA)
Main activity (MA) - Question identifier:MA_Q01
In the past 12 months, did you work at a job or business?
- 1: Yes
- 2: No
Main activity (MA) - Question identifier:MA_Q02
During the past 12 months, what was your main activity?
Was it:
- 01: Looking for paid work (e.g., searching for jobs, completing and submitting applications, participating in interviews and evaluations)
- 02: Going to school
- 03: Caring for your children
- 04: Household work
- 05: Retired
- 06: Maternity, paternity or parental leave
- 07: Long-term condition
- 08: Volunteering or care-giving other than for your children
- 09: Other specify:
Difficulties related to accessibility and employment (DAE)
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_R05
The following questions are about your main job in the past 12 months.
For multiple jobs, please think about the job where you worked the most hours.
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q05
Excluding overtime, on average, how many paid hours did you usually work per week in your main job?
Min = 0; Max = 999.9
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q10
In your main job, which of the following best described your work location?
- 1: Working from home all the time
- 2: Working outside of my home all the time
- 3: Working a hybrid model, sometimes from home and sometimes from outside of my home
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q15
If the opportunity to be employed was available, would you want to work?
- 1: Yes
- 2: No
- 3: Maybe depending on the opportunity available to me
- 4: Not applicable because of my condition
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_R20
The questions in this survey are about your unique personal experiences navigating accessibility and employment with your [conditions/condition].
The following questions are about difficulties you may or may not have experienced related to accessibility [at your main job/during any hiring process/which discouraged or prevented you from working at a job or business] because of your condition.
[Include searching for jobs, completing and submitting applications, interviews, and evaluations./BLANK]
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q20
In the past 12 months, have you experienced difficulties with any of the following features in the physical environment [at work/during a hiring process/which discouraged or prevented you from working a job or business] because of your condition?
- 01: Entrances or exits (e.g., narrow steps, lack of ramps, difficult to open doors)
- 02: Sidewalks or pedestrian paths (e.g., poor condition, difficulty with width or slope)
- 03: Layout of workplace (e.g., confusing floorplans, narrow hallways or stairs)
- 04: Lighting or sound levels
- 05: Lack of accessible parking, washrooms or elevators
- 06: Complicated or unclear signs
- 07: Other specify:
- 08: I have not experienced any difficulties with any features in the physical environment because of my condition
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q25
In the past 12 months, have you experienced any of the following difficulties related to technology [at work/during a hiring process/which discouraged or prevented you from working a job or business] because of your condition?
- 01: Lack of access to required adaptive hardware or software
- 02: Electronic files or documents with a lack of accessibility features
- 03: Virtual meeting platforms with a lack of accessibility features
- 04: Complicated or unclear technology (e.g., designs or navigation issues of websites)
- 05: Assistive technology not compatible with software
- 06: Poor Internet connectivity limited use of accessibility or adaptive features
- 07: Equipment or technology in need of repair or upgrade limited use of accessibility or adaptive features
- 08: Other specify:
- 09: I have not experienced any difficulties related to technology because of my condition
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q30
In the past 12 months, have you experienced any of the following difficulties related to communication [at work/during a hiring process/which discouraged or prevented you from working a job or business] because of your condition?
- 01: Physical and online materials not offered or available in alternate formats (e.g., embossed or electronic braille, large print hard copy or digital format, digital audio formats)
- 02: Instructions [or feedback/, feedback or job criteria] unclear or not given in plain language
- 03: Lack of availability of required technical communication aids (e.g., voice synthesizer, TTY, infrared system or portable note-taker)
- 04: Sign language interpretation services not offered or available
- 05: No captioning or verbal descriptions of images, videos or printed text [during interview/BLANK]
- 06: Physical or online materials with text size that was too small or font that was difficult to read
- 07: Files or documents that were unclear or poorly organized
- 08: Other specify:
- 09: I have not experienced any difficulties related to communication because of my condition
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q35
In the past 12 months, have you experienced any of the following difficulties related to transportation [getting to and from work/during a hiring process/which discouraged or prevented you from working at a job or business] because of your condition?
- 01: Commute route to [interview location/work location] was not on an accessible or reliable public transit line
- 02: Lack of available specialized personal or public transit (e.g., no specialized transportation service available in your area)
- 03: Lack of elevators in public transit stations or lack of ramps on public transit vehicles
- 04: Lack of audio announcements on public transit vehicles and stations
- 05: Difficulty making reservations or getting information about transportation services
- 06: Weather conditions or seasonal limitations
- 07: No attendant or companion available to help
- 08: Other specify:
- 09: I have not experienced any difficulties related to transportation because of my condition
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q40
In the past 12 months, have you experienced any of the following other difficulties [at work/during a hiring process/which discouraged or prevented you from working a job or business] because of your condition?
- 01: Difficulties related to accommodations (An accommodation is anything that may be considered as an adjustment or alternative arrangement, such as flexible work schedules, workstation modifications, specialized software or aids or assistive devices.)
- 02: Discrimination from [colleagues or managers/hiring staff/past colleagues or managers]
- 03: Lack of support or respect from [colleagues or managers/hiring staff/past colleagues or managers]
- 04: Did not feel comfortable disclosing disability or condition
- 05: Unaware of accessibility options in the workplace
- 06: Difficulties when starting a new job, position or role (e.g., no role clarity, slow process, information overload)
- 07: Training opportunities did not meet accessibility needs
- 08: Training or experience was not adequate for the current job market
- 09: Application or screening process was long or complex
- 10: Inaccessible online job application or automated screening process (e.g., website did not work with assistive device or limited formats offered)
- 11: Other specify:
- 12: I have not experienced any other difficulties because of my condition
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q45
In the past 12 months, to what extent did the difficulties you experienced [impact your ability to complete your daily work activities/impact your ability to complete required activities in a hiring process/discourage or prevent you from looking for work]?
- 1: To a great extent
- 2: To a moderate extent
- 3: To a small extent
- 4: Not at all
- 5: Don't know
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q50
To what extent do you agree or disagree with the following statement?
I can balance my work responsibilities with my health care and well-being priorities.
- 1: Strongly disagree
- 2: Somewhat disagree
- 3: Neither agree nor disagree
- 4: Somewhat agree
- 5: Strongly agree
- 6: Not applicable
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q55
To what extent do you agree or disagree with the following statement?
My work gives me the opportunity to use all my education, skills or work experience.
- 1: Strongly disagree
- 2: Somewhat disagree
- 3: Neither agree nor disagree
- 4: Somewhat agree
- 5: Strongly agree
- 6: Not applicable
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q60
To what extent do you agree or disagree with the following statement?
I would prefer to work more hours in a week.
- 1: Strongly disagree
- 2: Somewhat disagree
- 3: Neither agree nor disagree
- 4: Somewhat agree
- 5: Strongly agree
- 6: Not applicable
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q65
To what extent do you agree or disagree with the following statement?
I feel like I can equitably compete for promotion opportunities.
- 1: Strongly disagree
- 2: Somewhat disagree
- 3: Neither agree nor disagree
- 4: Somewhat agree
- 5: Strongly agree
- 6: Not applicable
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q70
To what extent do you agree or disagree with the following statement?
My employers provide me with adequate training and resources to do my job.
- 1: Strongly disagree
- 2: Somewhat disagree
- 3: Neither agree nor disagree
- 4: Somewhat agree
- 5: Strongly agree
- 6: Not applicable
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q75
To what extent do you agree or disagree with the following statement?
I am satisfied with the workplace accommodation measures that were implemented in my job.
- 1: Strongly disagree
- 2: Somewhat disagree
- 3: Neither agree nor disagree
- 4: Somewhat agree
- 5: Strongly agree
- 6: Not applicable
Difficulties related to accessibility and employment (DAE) - Question identifier:DAE_Q80
To what extent do you agree or disagree with the following statement?
I feel comfortable sharing concerns with my immediate supervisor about my accommodations.
- 1: Strongly disagree
- 2: Somewhat disagree
- 3: Neither agree nor disagree
- 4: Somewhat agree
- 5: Strongly agree
- 6: Not applicable
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