Please mark (x – or circle) your current age group

• 50–54

• 55–59

• 60–64

• 65–69

• 70–74

• 75 and over

Do you feel that your gender plays a role in any age discrimination you have experienced or observed?

• Yes/No

Were you working here before you turned 50?

• Yes/No

How many years have you been working here since the age of 50 or above?

Do you feel that any aspect has changed in your employment as you have become older?

• Yes/No

If yes, please elaborate on the things that have changed (positive and/or negative)

Have you been treated less favourably than other people because of your age? Please list ALL occasions when you were treated less favourably

Do you have a line manager who is significantly younger than you and if so, is this a problem?Yes/No

If yes, please explain in what way this is a problem

Are you aware of anybody else (in this workplace) you know who has experienced age discrimination in any way?

• Yes/No

If yes, please elaborate

Determining your choice to stay in this job, assign the percentage of importance you give to

• (1)

  Job satisfaction

• (2)

  Non-discrimination based on age

Although they have not directly told me, my employer or colleagues think that, because of my age: (Please choose one or more options from the following)

• a.

  I am too slow to learn new things

• b.

  My set of skills are outdated

• c.

  I should no longer be employed

• d.

  I cannot do my job properly or as well as a younger person

• e.

  I should have to retire

• f.

  I should not be considered for another job or offered a promotion

• g.

  I do not fit in with the culture of the workplace

• h.

  My duties, role or work hours should be changed

• i.

  I should be made casual

• j.

  I should not have access to training or courses or work opportunities

• k.

  My work is unsatisfactory

• l.

  I should not get a job/promotion that I was interviewed for

• m.

  OTHER (Specify) …… … … … … ….

Do you think you are above, below or on the median age of staff working here?

At any time since the age of 50, were you in a situation, at work or when looking for work, where you believed that you were treated less favourably than other people in a similar situation because of your age or because of assumptions made about older people, even though you were not told directly that your age was the reason?

• (1)

  Yes

• (2)

  No

If yes, did this episode occur when you were applying for a job or promotion with your current employer, when applying for a job with someone you were not employed by or in relation to some other aspect of your work?

• (1)

  A job/promotion with your current employer

• (2)

  A job with someone you were not employed by

• (3)

  Some other aspect of your work

What impact, if any, did that episode have on you? (Choose as many as applicable to your situation)

• Affected your

  • (1)

    Self-esteem and confidence

  • (2)

    Your mental health

  • (3)

    Caused you stress

  • Negatively impacted on

  • (4)

    Your family

  • (5)

    You financially

  • (6)

    Your career

  • (7)

    Your capacity to seek other work

  • (8)

    Thinking about or starting planning for retirement

  • (9)

    Consider changing your occupation or industry

  • (10)

    Consider accessing your superannuation fund

  • (11)

    Give up looking for work

  • (12)

    Consider retraining or updating my skills