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* 1. I identify by the following racial identity:

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* 2. I self-identify as the following sexual orientation:

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* 3. I am greeted with a smile each time I visit Piedmont Grocery.

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* 4. Piedmont Grocery has the products I desire in stock.

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* 5. Whenever I need assistance, it is easy to find an associate to help me.

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* 6. Piedmont Grocery store layout is customer friendly for the disabled (i.e. wide aisles, clear/large signage, wheelchair assessable, etc.)

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* 7. I have never had to complain to a Piedmont Grocery manager.

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* 8. Whenever I have a question, Piedmont Grocery staff responds in a professional manner.

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* 9. I have felt discriminated against at Piedmont Grocery due to my nationality or sexual orientation on one or more occasions.

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* 10. When I complain to a Piedmont Grocery manager, I have received a rude or unprofessional response.

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* 11. What is your age?

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* 12. Piedmont Grocery seeks my input on how to improve service at the store.

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* 13. While shopping Piedmont Grocery I notice many people of different colors and nationalities are employed.

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* 14. I have shopped Piedmont Grocery for:

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* 15. I've noticed frequent changes in Piedmont Grocery's service staff.

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* 16. I've had the opportunity to interact with a Piedmont Grocery supervisor.

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* 17. The Piedmont Grocery supervisor(s) I have interacted with are:

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* 18. I will continue to shop at Piedmont Grocery.

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* 19. I have the following suggestion(s) to improve customer experience at Piedmont Grocery.

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* 20. I feel very satisfied that my nationality, race, sexual orientation, religion, age, disability status and gender are respected at Piedmont Grocery

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* 21. Do you currently shop at Piedmont Grocery?

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* 22. How often do you shop at Piedmont Grocery?

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