Indigenous Cultural Safety Self-Assessment

Indigenous Cultural Safety Self-Assessment

This survey is about Indigenous Cultural Safety in the workplace. It has seven sections: Demographics, Understanding Indigenous Cultural Safety, Awareness and Values, Knowledge and Understanding, Skills and Abilities, Your Workplace and Organization, and Promising Practices.

The questions are wide-ranging in scope and difficulty. For example, some items are about the impact of Canada’s colonial history on Indigenous people. Other questions ask about recognizing and responding to racism against Indigenous people in the workplace. The issues addressed in the survey are, indeed, quite complex.

Whether you provide direct services or work more behind the scenes, your perspective is important. You may not know all the answers, but your views on the issues matter.

We appreciate your willingness to participate in this survey. Your responses will help us at INSERT PROJECT in our effort to improve healthcare services for Indigenous people across BC.

Thank you!


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This self-assessment survey is for training purposes only. BCAAFC has permission to use and adapt this tool from the San'yas ICS Training Program. The purpose of the strategy is to create safe and equitable healthcare experiences for Indigenous patients and families, as well as safer workplaces for Indigenous employees. The results of this survey will help improve services for Indigenous people throughout the region.


As employees, volunteers, visiting scholars, and privileged physicians, you are invited by the INSERT INVITATION SOURCE to complete this survey. Questions about your information and this survey may be directed to the INSERT CONTACT PERSON AND CONTACT LINK. Because this survey collects responses anonymously and cannot link them back to you, it will not be possible to withdraw your consent after you participate.


You do not have to participate. There will be no penalties if you do not want to participate. It will take approximately 20 minutes to complete the survey.


We do not intend to identify you. For open ended responses, please do not share information that might identify you or someone else. Any personally identifiable information that is provided in your responses to open-ended questions will be deleted when the results of the survey are compiled. When survey results are reported, presented, or published we will not include any data that could identify you.


Only the INSERT SPECIFIC TEAM and their technical support team will access survey responses. The INSERT NAME OF PROJECT TEAM will run the survey and analyze the results. Survey data will be stored in the INSERT PROJECT database electronically for seven years. You will not be provided with survey results.



I have read and understand this form. I voluntarily consent to INSERT PROJECT TEAM collecting, using, and disclosing the information I provide as a survey participant. Please mark your response below.