Sexual Harassment Survey
1. I am a __ woman __man
2. Do you believe you have ever been the victim of sexual harassment?
__Yes
__No
If No PLEASE GO TO QUESTION 12.
3. If Yes, did the sexual harassment occur
__on your present job
__on a previous job with the state (city, county)
__on a previous job with a different employer
4. When did it occur?
__ I am currently experiencing a sexual harassment problem
__ less than 2 years ago
__ more than 2 years ago
5. Who was (were) the harassers?
__ my immediate supervisor
__ higher management official(s)
__ union official
__ my co-worker(s)
__ clients, vendors or other non-employees
6. What was the nature of the harassment? Check all that apply.
__unwelcome sexual relations
__unwelcome physical contact (e.g., touching, pinching)
__graphic commentary on your body
__harassing phone calls
__propositions of a sexual nature
__sexually suggestive objects displayed in the workplace
__other _______________________________________________
______________________________________________________
7. Were any threats or insinuations made that your failure to submit to the harassment would adversely affect your employment?
__Yes
__No
8. Did you have adverse action taken against you because you refused to submit to the harassment?
__Yes-check all that apply
__denied promotion
__denied salary adjustment
__reprimand
__poor performance evaluation
__involuntary transfer
__discharge
__other
__No
9. What did you do about the harassment?
__nothing
__informally resolved the problem by talking to the harasser
__complained to management
__filed a grievance through the union
__filed discrimination charges with the federal Equal Employment
Opportunity Commission or state Fair Employment Practices Agency
__consulted an attorney and filed a lawsuit
10. If you approached the union for assistance, did you find the union helpful?
__Yes
__No
11. What was the outcome of your effort to stop the harassment?
__________________________________________________________
__________________________________________________________
__________________________________________________________
12. Do you have any opinions to share about how the union can more effectively respond to problems of sexual harassment?
__________________________________________________________
__________________________________________________________
__________________________________________________________
THANK YOU FOR COMPLETING THE QUESTIONNAIRE.
PLEASE RETURN IT IN THE ENVELOPE ENCLOSED.
