# Speaking-up barriers survey

Understand what makes raising concerns difficult.

If nothing was unclear or difficult, say so. Skip questions about steps you did not experience; use not applicable where appropriate.

## 1. When was it difficult to raise a concern?

Answer: ____________________

## 2. What response would make speaking up easier?

Answer: ____________________

## 3. Which channel feels suitable for questions?

Answer: ____________________

## Author notes / illustrative keys where applicable

1. The difficult concern-raising situation identifies the setting or interaction that inhibited participation. Keep disclosure optional and avoid identifiable incident details.
2. A desired response identifies an interaction that may reduce hesitation when raising a concern. Discuss appropriate team practices without soliciting identifiable incidents; anticipated comfort does not establish psychological safety or absence of harm.
3. A suitable question channel identifies where a respondent would feel able to ask; channel preference alone does not establish safety or freedom from harm.

Interpretation caution: Never promise anonymity without verified handling.