Form 1 Attachment 2 survey screenshot

Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Note: names, organizational codes, and email addresses of respondents will be provided to the survey
contractor ahead of data collection. Each respondent will receive a survey invitation email including
their name, email address, and a unique link to the survey, however, the invitation email will not
include their organizational code. Names, organizational codes, and email addresses of respondents
will not be included on the survey.
Landing Page: select Next to go to Position Type (REQUIRED)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Note: the first question on the survey is required (respondents must indicate their Position Type). All
other questions on the survey are optional and may be skipped to continue.
Position Type (REQUIRED): select position type. Depending on position type selected, scroll down for
next question (same screen) or Save and Continue to go to Workplace Satisfaction & Engagement

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Position Type: if Federal Employee, indicate if Trainee

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Position Type: If Federal Employee and Trainee, select Trainee Type then Save and Continue to go to
Workplace Satisfaction & Engagement

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Position Type: if Federal Employee but not Trainee, Save and Continue to go to Workplace Satisfaction
& Engagement

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Position Type: if Non-FTE Fellow, select Trainee Type then Save and Continue to go to Workplace
Satisfaction & Engagement

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Position Type: if Contractor, Save and Continue to go to Workplace Satisfaction & Engagement

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Position Type: if Volunteer, indicate if Trainee then Save and Continue to go to Workplace Satisfaction
& Engagement

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Position Type: if Other, Save and Continue to go to Workplace Satisfaction & Engagement

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Satisfaction & Engagement: if Federal Employee/Non-FTE
Fellow/Contractor/Volunteer/Other, rate level of agreement with the following statements then
scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Satisfaction & Engagement: if Federal Employee/Non-FTE Fellow/Volunteer/Other, rate
level of agreement with the following statements then Save and Continue to go to Workplace
Experiences & Interactions

Note: definitions are hidden from respondents unless “Show definitions” button is selected (applies to
all definitions in the survey). Definitions are hidden throughout for the purpose of the screenshot
submission.

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Satisfaction & Engagement: if Contractor, rate level of agreement with the following
statements then Save and Continue to go to Workplace Experiences & Interactions

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE
Fellow/Contractor/Volunteer/Other and have not felt discriminated against or treated unfairly, select
No then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE
Fellow/Contractor/Volunteer/Other and have felt discriminated against or treated unfairly, select Yes
then scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE
Fellow/Contractor/Volunteer/Other and selected Yes to previous question, indicate why you felt you
were discriminated against or treated unfairly then scroll down for next question (same screen)

Page 15 of 60

Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/Other and you
reported the incident(s) that caused you to experience discrimination or unfair treatment (selected
any option other than ‘I did not report this experience’), select who or where you reported the
incident(s) to, select the scenario that best represents your experience with the outcome then Save
and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Contractor and you reported the incident(s) that caused you
to experience discrimination or unfair treatment (selected any option other than ‘I did not report this
experience’), select who or where you reported the incident(s) to, select the scenario that best
represents your experience with the outcome then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/Other and you
did not report the incident(s) that caused you to experience discrimination or unfair treatment, select
‘I did not report this experience’ and indicate why you did not report the incident(s) then Save and
Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Contractor and you did not report the incident(s) that caused
you to experience discrimination or unfair treatment, indicate why you did not report the incident(s)
then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE
Fellow/Volunteer/Contractor/Other and you did not witness or experience any of the listed instances,
select N/A for all items then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE
Fellow/Volunteer/Contractor/Other and you witnessed (but did not experience) any of the listed
instances, select what you witnessed and scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/Other and you
witnessed (but did not experience) any of the listed instances and you reported the item(s) selected in
the previous question (selected any option other than ‘I did not report this experience’), select who or
where you reported the incident(s) to then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Contractor and you witnessed (but did not experience) any
of the listed instances and you reported the item(s) selected in the previous question (selected any
option other than ‘I did not report this experience’), select who or where you reported the incident(s)
to then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/Other and you
witnessed (but did not experience) any of the listed instances but did not report the incident(s) that
you witnessed, select ‘I did not report this experience’ and indicate why you did not report the
incident(s) then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Contractor and you witnessed (but did not experience) any
of the listed instances but did not report the incident(s) that you witnessed, select ‘I did not report
this experience’ and indicate why you did not report the incident(s) then Save and Continue to next
screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE
Fellow/Volunteer/Contractor/Other and you experienced any of the listed instances select what you
experienced and scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE
Fellow/Volunteer/Contractor/Other and you experienced any of the listed instances, indicate what
you feel the event(s) you experienced in the previous question was based on and scroll down for next
question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/Other and you
experienced any of the listed instances and you reported the item(s) selected in the previous question
(selected any option other than ‘I did not report this experience’), select who or where you reported
the incident(s) to, select the scenario that best represents your experience with the outcome then
Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Contractor and you experienced any of the listed instances
and you reported the item(s) selected in the previous question (selected any option other than ‘I did
not report this experience’), select who or where you reported the incident(s) to, select the scenario
that best represents your experience with the outcome then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/Other and you
experienced any of the listed instances but did not report the incident(s) that you experienced, select
‘I did not report this experience’ and indicate why you did not report the incident(s) then Save and
Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Contractor and you experienced any of the listed instances
but did not report the incident(s) that you experienced, select ‘I did not report this experience’ and
indicate why you did not report the incident(s) then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/Contractor/Other
and you did not witness and/or experience any of the following while conducting work at NIH and you
selected N/A for all items then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/Contractor/Other
and you witnessed and/or experienced any of the following while conducting work at NIH, select what
you witnessed and/or experienced then scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/Other and you
witnessed and/or experienced any of the items listed in the previous question while conducting work
at NIH and you reported the incident(s) (selected any option other than ‘I did not report this
experience’), select who or where you reported the incident(s) to and select the scenario that best
represents your experience with the outcome then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Contractor and you witnessed and/or experienced any of the
items listed in the previous question while conducting work at NIH and you reported the incident(s)
(selected any option other than ‘I did not report this experience’), select who or where you reported the
incident(s) to and select the scenario that best represents your experience with the outcome then Save
and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/Other and you
witnessed and/or experienced any of the items listed in the previous question while conducting work
at NIH but did not report the incident(s) that you witnessed and/or experienced, select ‘I did not
report this experience’ and indicate why you did not report the incident(s) then Save and Continue to
next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Contractor and you witnessed and/or experienced any of the
items listed in the previous question while conducting work at NIH but did not report the incident(s)
that you witnessed and/or experienced, select ‘I did not report this experience’ and indicate why you
did not report the incident(s) then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/Other, rate
your level agreement with the following statements then scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Contractor, rate your level agreement with the following
statements then scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/
Contractor/Other, select the ways your supervisor/IC leadership raised awareness about diversity,
equity, and inclusion in the workplace in the past 12 months then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee, rate your level of agreement with the
following statements and scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Non-FTE Fellow/Volunteer/Contractor/Other, rate your level
of agreement with the following statements and scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Experiences & Interactions: if Federal Employee/Non-FTE Fellow/Volunteer/
Contractor/Other, rate your level of agreement with the following statements then Save and Continue
to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Satisfaction: if Federal Employee/Non-FTE Fellow/Volunteer/Other and you are not
considering leaving your work unit within the next year, select No then Save and Continue to next
screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Satisfaction: if Federal Employee/Non-FTE Fellow/Volunteer/Other and are considering
leaving your work unit within the next year, select Yes and indicate what you intend to do after
leaving your work unit then scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Satisfaction: if Federal Employee/Non-FTE Fellow/Volunteer/Other and are considering
leaving your work unit within the next year but are not considering leaving your work unit partly or
entirely based on any of the following, select None of the above then Save and Continue to
Demographic Information

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Satisfaction: if Federal Employee/Non-FTE Fellow/Volunteer/Other and are considering
leaving your work unit within the next year partly or entirely based on any of the following, select all
that apply then scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Workplace Satisfaction: if Federal Employee/Non-FTE Fellow/Volunteer/Other and are considering
leaving your work unit within the next year, indicate whether you feel your experience in the previous
question was based on any of the following then Save and Continue to Demographic Information

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Demographic Information: if Federal Employee/Non-FTE Fellow/Volunteer/Contractor/Other specify
how many years you have worked at NIH and the highest degree or level of education you have
completed then scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Demographic Information: if Federal Employee indicate whether you are an official supervisor based
on the provided definition, select your age range, then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Demographic Information: if Non-FTE Fellow/Volunteer/Other indicate whether you are an unofficial
supervisor based on the provided definition, select your age range, then Save and Continue to next
screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Demographic Information: if Contractor, select your age range, then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Demographic Information: if Federal Employee/Non-FTE Fellow/Volunteer/Contractor/Other and you
do not have a disability, are unsure whether you have a disability, or choose to disclose whether you
have a disability, specify whether you are of Hispanic, Latino, or Spanish origin then scroll down for
next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Demographic Information: if Federal Employee/Non-FTE Fellow/Volunteer/Contractor/Other and you
do have a disability, select Yes then scroll down for next question (same screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Demographic Information: if Federal Employee/Non-FTE Fellow/Volunteer/Contractor/Other and you
do have a disability, indicate how you would describe the nature of your disability and specify
whether you are of Hispanic, Latino, or Spanish origin then scroll down for next question (same
screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Demographic Information: if Federal Employee/Non-FTE Fellow/Volunteer/Contractor/Other select
the option(s) that best describes your race then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Demographic Information: if Federal Employee/Non-FTE Fellow/Volunteer/Contractor/Other select
the option that best describes your sexual orientation then scroll down for next question (same
screen)

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Demographic Information: if Federal Employee/Non-FTE Fellow/Volunteer/Contractor/Other select
the option(s) that best describe your current gender identity, select the sex you were assigned at
birth, on your original birth certificate then Save and Continue to next screen

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

End Survey: if Federal Employee/Non-FTE Fellow/Volunteer/Contractor/Other select Back to edit your
responses or select Submit Survey to submit your responses and go to Thank You Page

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Link to programmed survey: https://westatgov.gov1.qualtrics.com/jfe/form/SV_aXce1zrEaccEjhI

Thank You Page: if Federal Employee/Non-FTE Fellow/Volunteer/Contractor/Other and submitted
survey, view Thank You Page

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