Full Engagement Intake Questionnaire

To intiate the S.A.F.E. Score Certified Employer™ track, please provide the following operational data. This intake portal is confidential and securely processed.

Your Name*

Your email*

Legal Organization Name*

Corporate Website URL*

Primary Industry Sector *

Organizational Structure*

For Profit

Non Profit

Government

Total Organizational Headcount*

Number of Corporate, Operating and Brand Locations*

International Presence*

Domestic US Operations Only

US Operations with International Entities ( Note:S.A.F.E. Score Certified Employer™ apply to US operations only)

Labor Relations Status*

Non Unionized Workforce

Unionized Workforce/ Active Collective Bargaining Agreements

Blended Workforce ( Both Union and Non-Union Segements)

Workforce Model*

100% Remote/Distributed

100% On-Site/ Brick-and-Mortar

Hybrid Model ( Structured or Flexible)

Current Neurodiversity or Accessibility Frameworks or Programs*

Active Neurodiversity Employee Resource Group or Affinity Group

Existig DEI Board/ Function

Genaral Mandatory Awareness Training Only

No Existing Infrastructure or Programs/ Starting from Baseline

Primary Strategic Objective for S.A.F.E. Certification*

Proactive Risk Mitigation & Compliance Stabilization

Systemic Audit and Competitive Advantage

Regulatory Response ( EEOC, Judical Mandate, or Active Institutional Liability)

Current Internal Sentiment/ Cultural Climate Regarding Neurodiversity*

High Urgency

Receptive

Neutral

Apprehensive or Internal Hesitation

Designated Internal Steering Commitee/Responsible Team *

Organizational Commitment Level for Structural/Policy Implementation*

100% Committed to Systemic Realignment

Exploring Framework Feasibility & Practical Application

Requires Preliminary Board/Executive Briefing

Stakeholder Alignment & Verified Contact

Contact

Email

contact@inclusion-bydesign.com

Mission

S.A.F.E. Score Framework™

The Disclosure Workbook

Book Denise Malone-Cash, DSL

Become a S.A.F.E. Score Certified Employer™

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