Single Equality Scheme Consultation
Listening to Your Views

Q.1. Do you support the Bolton PCT in its aim to eliminate discrimination and unfair treatment?

Yes  No  Don't Know

Q.2 Do you feel that our plans will make a difference in addressing equality and diversity issues?

Yes  No  Don't Know

If No or Don’t Know please say how we can make them better?

From your own experience, or those you care for, what equality and diversity issues do you feel the Bolton PCT should be addressing? PLEASE WRITE IN BELOW

About You

To ensure that we are meeting the needs of everyone, it is important that we ask you a few questions about yourself or the organisation that you represent. As with all the questions, your answers will be completely confidential.

Q.1 Are you:

Responding on behalf of an organisation   A PCT employee   A member of the public

Q.2 Do you work for:

The NHS   Voluntary or community sector   Local Government   Private Sector

Q.3 Are you male or female?

Male     Female

Q.4 Do you have any long-standing illness, disability or infirmity?
(long-standing means anything that has troubled you over a period of time or that is likely to affect you over a period of time)

Yes    No

Q.5 What is your age?

Under25    25-35    36-50    51+

Q.6 Which of these groups do you consider you belong? Please Tick ü One Box Only

Enter other description

Q.7 Which of the following best describes your religion or belief? Please Tick ü One Box Only

Atheist            Buddhist              Christian            Hindu        Jainism
Jewish             Muslim                Sikh                  None
Other

Enter other religion or belief

Q.8 How would you describe your sexual orientation? Please Tick ü One Box Only

Lesbian   Gay   Bisexual    Heterosexual

Q.9 Would you be willing to participate in future consultation on equality and diversity run by Bolton PCT?

Yes   No   Don't know

If Yes, please provide the following contact information:

Name
Street Address
Address (cont.)
Town/ City
County
Post Code
Country
E-mail