The Equality Standard for Sport Equality Monitoring Form Revised September 2012

This form is provided as guidance for Scottish governing bodies of sport when collecting monitoring data as part of the requirements for the Equality Standard for Sport.

It is assumed that the governing body will follow its own data protection policy, so please read the covering letter properly and amend as required.

This form is for use when collecting data on people who are over the age of 16.

Governing bodies might find it easier to collect this information using an electronic survey tool, many of which are available online.

For more information and guidance, please discuss this with your Designated Support Lead allocated by Plan4Sport or your Partnership Manager.

Private and Confidential

Governing Body Name

Equality Monitoring Form

Governing Body Nameis committed to making yoursport accessible to all. This will be accomplished by upholding the principles of equality in all aspects of our work. We will audit and monitor our business activities regularly, and take appropriate steps if it appears that our commitment to equality is not being delivered effectively.

We are collecting data on the profile of our staff (paid and unpaid) / coaches / officials / board / members/ participantsin terms of equality.

Your cooperation in helping us to gather this monitoring information will greatly aid our efforts to ensure that all staff (paid and unpaid) / coaches / officials / board / members/ participants are treated fairly regardless of age, race, disability, sex, gender identity, sexual orientation, religion or belief.

Without this data, it will not be possible to identify any current areas of under-representation or potential inequalities, and as such, it will make it much more difficult for us to tackle these issues.

This work is being carried out as part of our responsibilities under the Equality Act 2010 and as part of the accreditation process for the Equality Standard for Sport.

How your personal information will be treated

Responses will be treated in the strictest confidence, in line with the principles of the Data Protection Act 1998. This means that:

Your information will be stored securely with restricted access; Information will be anonymous(this means that there will be no way in which you can be identified),

there is nowhere on the form that asks for your name; and Information will be combined in the form of summary reports which will be reported to our board and

published on our website.

Instructions for completion

Your response should be returned in a sealed envelope marked "private and confidential" to the below address:

Insert contact name and address details for the person at your SGB who is responsible for collecting and analysing the data:Address detailsAddress details

You are not obliged to answer all of the questions.

If you have any questions, please contact enter contact name, telephone number and email address.

We hope that you will take the time to complete the attached survey and return this to usThank you in advance of your cooperation.

Name of Chair or CEO

2

Private and Confidential

Consent

Please tick to confirm your consent for us to collect your personal data in line with the Data Protection Act 1998

I have read and understood the covering letter which outlines the reasons for collecting my personal information and how this information will be treated

Please tick: Please write in the date:

Your RolePlease indicate how you are involved in your sport by ticking one of the boxes below:

Staff (paid)

Staff (unpaid)

Coach

Official

Member or participant

Board

I would prefer not to answer this question

Age

Please indicate your age by ticking one of the boxes below

16 – 24 45 – 54

24 – 34 55 – 64

35 – 44 65 – 74

75+

I would prefer not to answer this question

Caring Responsibility

Are you the primary caregiver to a child or children, or other dependents including disabled, elderly or sick adults?

Yes

3

Private and Confidential

No

I would prefer not to answer this question

Disability

The Equality Act 2010 defines disability as:

“A person has a disability if s/he has a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities.”

Do you consider yourself to be disabled?

Yes

No

I would prefer not to answer this question

Please identify the nature of your disability:

Deafness or partial hearing loss

Blindness or partial sight loss

Learning disability

Learning difficulty

Developmental disorder

Physical disability

Mental health condition

Long term illness, disease or condition

Other condition, please write in

Scottish Official Statistics: Categories from the Scottish Census 2011

I would prefer not to answer this question

4

Private and Confidential

Ethnic Group

Please indicate your ethnic group by ticking one of the boxes below

White

Scottish

Other British

Irish

Gypsy Traveller

Polish

Any other white ethnic group, please write in:

Mixed or multiple ethnic origin, please write in:

Asian, Asian Scottish or Asian British

Pakistani, Pakistani Scottish or Pakistani British

Indian, Indian Scottish or Indian British

Bangladeshi, Bangladeshi Scottish or Bangladeshi British

Chinese, Chinese Scottish or Chinese British

Other, please write in:

African

African, African Scottish or African British

Caribbean or Black

Caribbean, Caribbean Scottish or Caribbean British

Black, Black Scottish or Black British

Other, please write in:

Other Ethnic Group

Arab, Arab Scottish or Arab British

Other, please write in:Scottish Official Statistics: Categories from the Scottish Census 2011

I would prefer not to answer this question

Equality Monitoring Form 5The Equality Standard for Sport, Revised September 2012

Private and Confidential

Religion or belief

What religion, religious denomination or body do you belong to?

None

Church of Scotland

Roman Catholic

Other Christian, please write in

Muslim

Buddhist

Sikh

Jewish

Hindu

Another religion or body, please write inScottish Official Statistics: Categories from the Scottish Census 2011

I would prefer not to answer this question

Sex and Gender Identity

Please indicate your sex by ticking one of the boxes below:

Male

Female

I would prefer not to answer this question

Have you ever identified as transgender?

Yes

No

I would prefer not to answer this question

Equality Monitoring Form 6The Equality Standard for Sport, Revised September 2012

Private and Confidential

Sexual Orientation

Please indicate which of the following best describes how you think about yourself by ticking one of the boxes below:

Gay Man

Gay Woman

Lesbian

Heterosexual/Straight

Other

I would prefer not to answer this question

Thank you for taking the time to fill out this survey.

Equality Monitoring Form 7The Equality Standard for Sport, Revised September 2012