Its all about you - Census

Help us deliver the services that meet your needs.

We want to give residents the best possible service. Different people from different communities have different needs. The starting point for delivering better services is to understand who is using them.

We use this information to improve services for residents, ensure resources are targeted to the people who need them and to identify communities not making use of our services.

In addition, every new or changed policy or service undergoes an equality analysis to ensure everyone is treated fairly and that no group experiences discrimination.

Without knowing who you are, we cannot carry out this analysis and cannot ensure that we are treating people fairly.

We also want to ensure we can offer support to those who feel they would benefit, such as other household members with disabilities or people seeking help to secure long-term employment.

Please take a few moments to complete the all of the questions below:

Question Title

About You

Title:

First Name:

Surname:

Address:

Postcode

Phone Number:

Question Title

Date of Birth

(DD/MM/YYYY)

Date

Question Title

Are you:

Male

Female

Question Title

1. Employment - Work Status (tick one box only)

	Tenant	Partner/ Spouse
Employee in full time job (30 hours or more per week).	Employee in full time job (30 hours or more per week). Tenant	Employee in full time job (30 hours or more per week). Partner/ Spouse
Employee in part time job (Less than 30 hours per week).	Employee in part time job (Less than 30 hours per week). Tenant	Employee in part time job (Less than 30 hours per week). Partner/ Spouse
Self employed - full or part time.	Self employed - full or part time. Tenant	Self employed - full or part time. Partner/ Spouse
Government supported training.	Government supported training. Tenant	Government supported training. Partner/ Spouse
Unemployed and available for work.	Unemployed and available for work. Tenant	Unemployed and available for work. Partner/ Spouse
Wholly retired from work.	Wholly retired from work. Tenant	Wholly retired from work. Partner/ Spouse
Full-time education at school, college or university.	Full-time education at school, college or university. Tenant	Full-time education at school, college or university. Partner/ Spouse
Looking after family/home.	Looking after family/home. Tenant	Looking after family/home. Partner/ Spouse
Permanently sick/disabled.	Permanently sick/disabled. Tenant	Permanently sick/disabled. Partner/ Spouse
Doing something else.	Doing something else. Tenant	Doing something else. Partner/ Spouse
Not applicable.	Not applicable. Tenant	Not applicable. Partner/ Spouse

Any comments

Question Title

2. Which group do you consider yourself to belong?

White British

White Irish

Turkish/Turkish Cypriot

Greek/Greek Cypriot

Other White (please state)

Black Caribbean

Black African

Black British

Black Other (please state)

Asian Indian

Asian Pakistani

Asian Bangladeshi

Asian British

Asian Other (please state)

Multi Heritage White & Black Caribbean

Multi Heritage White & Black African

Multi Heritage White & Asian

Multi Heritage Other (please state)

Any Other (please state)

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3. Is English your preferred language?

Yes

If not, please specify your preferred language

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4. Do you consider yourself to be disabled?

Yes (If yes, please tick the options that apply to you)

Wheelchair user

Mobility problems

Hard of hearing

Deaf

Registered blind

Mental health problems

Learning difficulties

Language difficulties

Visually impared

Long term illness or any other impairment (please state)

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5. Would any of the following be useful to you?

Interpreter

Large print

Typetalk/Minicom

Signer

Induction Loop

Audiotape/CD

Home visit

Any comments

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6. Which is your preferred method of contact?

Telephone

Letter

Home visit

Other (please specify)

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7. Religion

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

No Religion

Prefer not to answer

Other (please specify)

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8. Sexuality

Heterosexual/straight

Gay Man

Gay woman/lesbian

Bisexual

Prefer not to answer

Any comments

Question Title

About your household.
Please list below details of everyone who normally lives with you.

Person 1 Title:

Person 1 First Name:

Person 1 Surname:

Date of Birth (DD/MM/YYYY)

Relationship to tenant

Does this person have a Disability (If yes, please specify)

Question Title

About your household.
Please list below details of everyone who normally lives with you.

Person 2 Title:

Person 2 First Name:

Person 2 Surname:

Date of Birth (DD/MM/YYYY)

Relationship to tenant

Does this person have a Disability (If yes, please specify)

Question Title

About your household.
Please list below details of everyone who normally lives with you.

Person 3 Title:

Person 3 First Name:

Person 3 Surname:

Date of Birth (DD/MM/YYYY)

Relationship to tenant

Does this person have a Disability (If yes, please specify)

Question Title

About your household.
Please list below details of everyone who normally lives with you.

Person 4 Title:

Person 4 First Name:

Person 4 Surname:

Date of Birth (DD/MM/YYYY)

Relationship to tenant

Does this person have a Disability (If yes, please specify)

Question Title

About your household.
Please list below details of everyone who normally lives with you.

Person 5 Title:

Person 5 First Name:

Person 5 Surname:

Date of Birth (DD/MM/YYYY)

Relationship to tenant

Does this person have a Disability (If yes, please specify)

Question Title

About your household.
Please list below details of everyone who normally lives with you.

Person 6 Title:

Person 6 First Name:

Person 6 Surname:

Date of Birth (DD/MM/YYYY)

Relationship to tenant

Does this person have a Disability (If yes, please specify)

Question Title

About your household.
Please list below details of everyone who normally lives with you.

Person 7 Title:

Person 7 First Name:

Person 7 Surname:

Date of Birth (DD/MM/YYYY)

Relationship to tenant

Does this person have a Disability (If yes, please specify)

Question Title

About your household.
Please list below details of everyone who normally lives with you.

Person 8 Title:

Person 8 First Name:

Person 8 Surname:

Date of Birth (DD/MM/YYYY)

Relationship to tenant

Does this person have a Disability (If yes, please specify)

Question Title

Privacy Statement
Information you provide enables us to carry out equality analysis to help tailor our services to the individual and collective needs of our customers, in line with the requirements of the Equality Act 2010. We may share your information with Barnet Council and our repairs partners Mears, Mitie and Lovell for the same purpose. We may also look at this information alongside information held by Barnet Council.

You have the right to request a copy of the information we hold about you. Please see our full privacy statement on our website for details of how to get in touch. We want to make sure that your personal information is accurate and up to date. You may ask us to correct or remove information you think is inaccurate. If you have a concern or complaint regarding this process, please email customer.care@barnethomes.org or write to: The Data Controller, Barnet Homes, 9th Floor, Barnet House, 1255 High Road, London N20 0EJ. If you are unhappy with our response you may contact the Information Commissioner’s Office (ICO) on 0303 123 1113 and complain to them directly.

For more information on how your information is used and how we maintain security of your information, please see the detailed Privacy Statement on our website at www.barnethomes.org or write to The Data Controller, at the address above.

Yes. I give Barnet Homes permission to use my information in accordance with this privacy statement.

Date (DD/MM/YYYY):

Thank you for you time in completing this questionnaire

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About You

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Date of Birth

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Are you:

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1. Employment - Work Status (tick one box only)

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2. Which group do you consider yourself to belong?

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3. Is English your preferred language?

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4. Do you consider yourself to be disabled?

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5. Would any of the following be useful to you?

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6. Which is your preferred method of contact?

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7. Religion

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8. Sexuality

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About your household.Please list below details of everyone who normally lives with you.

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About your household.Please list below details of everyone who normally lives with you.

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About your household.Please list below details of everyone who normally lives with you.

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About your household.Please list below details of everyone who normally lives with you.

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About your household.Please list below details of everyone who normally lives with you.

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About your household.Please list below details of everyone who normally lives with you.

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About your household.Please list below details of everyone who normally lives with you.

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About your household.Please list below details of everyone who normally lives with you.

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About your household.
Please list below details of everyone who normally lives with you.

About your household.
Please list below details of everyone who normally lives with you.

About your household.
Please list below details of everyone who normally lives with you.

About your household.
Please list below details of everyone who normally lives with you.

About your household.
Please list below details of everyone who normally lives with you.

About your household.
Please list below details of everyone who normally lives with you.

About your household.
Please list below details of everyone who normally lives with you.

About your household.
Please list below details of everyone who normally lives with you.