(1) Do you work with any foreigners?
(2)If yes, do you have any problems understanding each other?
(3) If yes, what are those problems?
(a) Language
(b) Values
(c) Culture and religion
(d) Nothing specifically
(4) If you do have problems, has your company enacted any measures to deal with the issue?
(5) If yes, what kind of measures?
(a) Making English the common language
(b) Meetings and training to promote shared values
(c) Personnel department works towards promoting fairness
(d) Parties and events to help understand other cultures
(6) Feel free to write any about any other problems or observations about working with foreigners.
The other questions ask the respondent to mention industry, rank and age.
Not a terrible idea and the final feature might yet be interesting but I think the structure of these questions might be called "leading the witness".