Skip to content
Public Protection Service Equality Monitoring Form
*
1.
Please confirm which service area you have had contact with recently:
(Required.)
Air Quality
Animal Health
Collection of Dogs
Commerce
Complete a Customer Survey
Contaminated Land
Corporate Health and Safety
Don't know
Fair Trading
Food Safety
Health and Safety
Licensing
Not Applicable
Pest Control
Pollution
Public Health (inc. Noise issues, drainage)
2.
Are you?
Female
Male
3.
Which best describes your ethnicity?
White British
MIxed - White & Black Caribbean
Mixed - White & Back African
Mixed - White and Asian
Asian/Asian British - Indian
Asian/Asian British - Pakistani
Asian/Asian British - Bangladeshi
Black/Black British - Caribben
Black/Black British - African
Chinese/Chinese British - Chinese
Chinese/Chinese British - Chinese British
Any other Background - Gypsy
Any other background - Irish Traveller
Any other background - Other
Any other background (please specify)
4.
Which best describes your age group?
16-18
19-25
26-29
30-39
40-49
50-59
60-64
65+
Prefer not to say
5.
Which best describes your religion or belief:
No religion or belief
Christian
Buddhist
Muslim
Hindu
Jewish
Sikh
Prefer not to say
Other (please specify)
