EMPLOYMENT INFORMATION
California department or agency where you are employed:
Location (city) of California department or agency where you are employed:
Number of years employed by California department or agency:
Full-time or Part-time:
If you belong to a union, which union and which bargaining unit:
Job Title:
Approximately how many deaf and/or hard of hearing employees are employed at your department location?:
What are the biggest problems facing deaf and/or hard of hearing employees ar your department?:
Job Description (what do you do?):
How many hours a week do you receive interpreting services?:
Are interpreting services provided on a regular basis or only when requested?:
For what activities (i.e. meetings / client contact etc…) are interpretive services typically provided?:
What is the process for requesting an interpreter at your department/agency? :
Who is the person in charge of providing interpreters at your department/agency?:
Have you ever requested an interpreter and had the request ignored or denied?:
If you answered yes to the above question, please describe (provide dates if possisble):
For what activities do you think interpreters should be provided but are not?:
Has management ever tried to convince you that you don’t need an interpreter for a meeting?:
If you answered yes to the above question, please describe:
Has management ever relied on a fellow employee to interpret for you?:
If you answered yes to the above question, please describe:
Are interpreters provided for staff meetings?:
If you answered no to the above question, please describe why not:
If no interpreters are provided, how is the training material communicated to you?:
Are interpreters provided for training events:
If you answered no to the above question, please describe why not:
If no interpreters are provided, what attempts are made to communicate with you?:
Does the department provide captioning for videos shown at work?:
What videos don't have captioning that should?:
Have you ever asked for a captioned video, and if so, what was the outcome?:
Are interpreters provided for performance reviews?
If you answered no to the above question, please describe why not:
If no interpreter is provided, how is the information in your review communicated to you? :
If no interpreter is provided, how do you communicate with your employer about your performance review?:
Are interpreters provided for disciplinary actions?:
If you answered no to the above question, please describe why not:
If no interpreters are provided, how is this information communicated to you?:
Have you ever had any problems with interpreter “no-shows”?
If you answered yes to the above question, please describe:
If an interpreter fails to show up what happens?:
Do meetings go ahead or are they rescheduled?:
Have you ever had any problems with the quality of interpreting services?:
If you answered yes to the above question, please describe:
Has your employer ever consulted you about the selection of an interpreter?:
If you could request a specific interpreter, would that be helpful to your job performance?:
If so, how?:
Do you have a videophone at your job?:
If yes, when did you get a videophone?:
How are reasonable accommodations (other than interpreters) handled in your department?:
Who is in charge of handling requests for reasonable accommodations?:
Have you ever had any problems obtaining a videophone as a reasonable accommodation?:
Have you ever experienced a delay receiving a videophone when one was requested?:
Have you ever been asked to use a videophone instead of using an interpreter?:
Do you ever think you are being discriminated against because you are deaf or hard of hearing? :
If yes, please explain:
Does management understand your communication needs as a deaf or hard of hearing employee? :
If no, Why not? :
Do you think you are fully integrated into your workplace? :
If no, Why not? :
Do you think you have had an equal opportunity to obtain promotions? :
If no, Why not? :
Please list jobs for which you applied but did not receive a promotion (list job title and date applied if possible)?:
Have you initiated any formal complaints with your employer about interpretive services or the denial of reasonable accommodations? :
What was the outcome, if any? :
Do you have documentation of these complaints? :
Do you have any documents (passed notes, emails etc…) about your department’s failure to provide you with interpreters or other reasonable accommodations? :
Please provide any additional comments or information you think would assist our investigation:
Please provide the names and contact information of any other individuals (deaf and/or hard of hearing) that may have observed or experienced discrimination against the deaf at your state agency:
