Assess Your Workplace, Part 1: For Employees
Please complete the checklist below. 
General Workplace Culture
Question	Yes	No	N/A	
Do coworkers show that they are aware of the challenges that women may face in traditionally male workplace environments?	□	□	□	
Are job titles, job descriptions and job ads inclusive of women?	□	□	□	
Are the physical working conditions (e.g. equipment, clothing, shower, and toilet facilities) appropriate for men and women?	□	□	□	
Do workplace decisions reflect individual differences rather than assuming that all women (and/or all men) have the same needs/concerns?	□	□	□	
Are promotions, pay, and performance evaluations clearly available and based on objective criteria?	□	□	□	
Is mentoring encouraged/provided?	□	□	□	
Do women in the workplace have the opportunity to see and communicate with women role models in senior roles?	□	□	□	
Is it made clear to all levels that harassment complaints are taken seriously, quickly addressed, and resolved without negative consequences for the complainant?	□	□	□	
Are you aware of the formal and informal mechanisms for handling conflict?
Do you have any additional comments or concerns you wish to share regarding harassment in the workplace? Provide your answer here.

				

Violence/Harassment Employee Survey
Question	Yes	No	Unsure	
My employer has a written violence/harassment prevention policy.	□	□	□	
My workplace has clearly established procedures and expectations for violence/harassment prevention.	□	□	□	
My workplace has its violence/harassment prevention policy posted in a place accessible to all employees.	□	□	□	
I have received formal training in the area of workplace violence/harassment.	□	□	□	
I know what constitutes workplace violence/harassment.	□	□	□	
I know the disciplinary action that can be taken against me if I cause a workplace harassment/violence incident.	□	□	□	
I know what to do when I witness, or am involved in, a workplace violence/harassment incident.	□	□	□	
I am aware of the controls and safety procedures implemented in the workplace to protect me from workplace violence/harassment.	□	□	□	

Additional Comments:

Assess Your Workplace, Part 2: For Employers
Workplace assessments are useful to determine your current workplace culture and knowledge. They are also helpful in finding any areas that need to be fixed or addressed. Assessments can help you establish a baseline and then develop strategies to improve your policies and procedures.

Note: If you answer “no” or “unsure” to any of these questions, you will need to take action to implement or improve your Workplace Respect Policy.
Question	Yes	No	Unsure	
Does your organization have a respect policy that includes violations of respect categorized as unprofessional conduct, harassment (including bullying, cultural insensitivity and discrimination) and workplace violence?	□	□	□	
Does your organization have a Workplace Respect Administrator?	□	□	□	
Is the Workplace Respect Policy readily available to supervisors and employees?	□	□	□	
Is this policy reviewed during orientation/onboarding?	□	□	□	
Are employees trained to recognize and respond to violations of respect in the workplace?	□	□	□	
Is management trained in dealing with violations of respect?	□	□	□	
Do employees know where to go for more information, and who to contact if a violation occurs?	□	□	□	
Is your workplace reasonably free from violations of respect?	□	□	□	
Created originally by Construction Owners Association of Alberta, 2011.This form is for example purposes only. Completing this form alone will not necessarily put you in compliance with the legislation. It is important and necessary that you customize this document to meet the unique circumstances of your worksite. Further, it is essential that this document is not only complete, but is used, communicated, and implemented in accordance with the legislation. The YWCA, its members, affiliates, employees or agents will not be liable to you for any damages, direct or indirect, arising out of your use of this form.

Assess Your Workplace, Part 3: Is Your Workplace Respect Policy Enforceable?
Note: If you answer “no” or “unsure” to any of these questions, you will need to take action to implement or improve your Workplace Respect Policy.

Question	Yes	No	Unsure	
Are all employees aware of your Workplace Respect Policy?	□	□	□	
Is the policy clearly and consistently communicated to all employees?	□	□	□	
Do supervisors understand their obligations with regard to reporting incidents?	□	□	□	
Do supervisors receive training on recognizing and handling incidents of workplace disrespect?	□	□	□	
Does your organization have processes in place to deal with incidents of unprofessional conduct, harassment (including bullying, cultural insensitivity, and discrimination), or occupational violence (violations of respect)?	□	□	□	
During orientation, do you have employees sign a non-violence/anti-discrimination agreement?	□	□	□	
Is your policy meaningful and understandable?	□	□	□	
Do the senior leaders in your organization model behaviours that support a respectful workplace?	□	□	□	
Created originally by Construction Owners Association of Alberta, 2011. This form is for example purposes only. Completing this form alone will not necessarily put you in compliance with the legislation. It is important and necessary that you customize this document to meet the unique circumstances of your worksite. Further, it is essential that this document is not only complete, but is used, communicated, and implemented in accordance with the legislation. The YWCA, its members, affiliates, employees or agents will not be liable to you for any damages, direct or indirect, arising out of your use of this form.