Would you describe yourself as: Male Female Prefer not to say Age monitoring To which age band do you belong? 16 19 20 24 25 29 30 34 – – – – 35 39 40 44 45 49 50 54 – – – – 55 59 60 64 65 70 71 74 – – – – 75 + Prefer not to say Disability monitoring The Equality Act 2010 (Disability Discrimination Act 1995) has defined disability as follows; or mental impairment which has a substantial and long-term adverse effect on “A physical your ability to carry out normal day-to-day activities” Do you consider yourself to have a disability or a long-term health condition? Yes No If yes, what is the effect or impact of your disability or health condition? Prefer not to say
Would you describe yourself as: Male Female Prefer not to say Age monitoring To which age band do you belong? 16 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50 – 54 55 – 59 60 – 64 65 – 70 71 – 74 75 + Prefer not to say Disability monitoring The Equality Act 2010 (Disability Discrimination Act 1995) has defined disability as follows; “A physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities” Do you consider yourself to have a disability or a long-term health condition? Yes No If yes, what is the effect or impact of your disability or health condition? Prefer not to say
4.%20age%20uk%20lk%20equal%20opps%20monitoring.docx