walking distances, climbing stairs, lifting and carrying objects Learning or concentrating or remembering Mental Health Stamina or breathing difficulty Social or behavioural issues (e.g. due to neuro diverse conditions such as Autism, Attention Deficit Disorder or Asperger’s Syndrome) Other impairment Heterosexual / straight Which of the following options best Lesbian / Gay woman describes your sexual orientation? Gay man Bisexual Other Prefer not to say What is your religion or belief? No religion Buddhist Christian Jewish Muslim Sikh Any other religion Prefer not to say Do you look after, or give any help or Long-term physical or mental • support to family members, friends, ill-health / disability neighbours or others because of either: Problems related to old age • Yes No Prefer not to say
walking distances, climbing stairs, lifting and carrying objects Learning or concentrating or remembering Mental Health Stamina or breathing difficulty Social or behavioural issues (e.g. due to neuro diverse conditions such as Autism, Attention Deficit Disorder or Asperger’s Syndrome) Other impairment Which of the following options best describes your sexual orientation? Heterosexual / straight Lesbian / Gay woman Gay man Bisexual Other Prefer not to say What is your religion or belief? No religion Buddhist Christian Jewish Muslim Sikh Any other religion Prefer not to say Do you look after, or give any help or support to family members, friends, neighbours or others because of either: • Long-term physical or mental ill-health / disability • Problems related to old age Yes No Prefer not to say
C4CC-Equality-Monitoring-Form-Final.docx