WORK LIFE BALANCE QUESTIONNAIRE Please fill in the following informations:

NAME: FAMILY: MARRIED: YES If yes, is he NO BUSINESS

AGE:

EMPLOYED NO

CHILDREN: YES

If yes , no of children ________

Age: 1 )___ 2 )___ 3 )___

What is the nature of your work?_______________ Name of the organization?__________________ What is your role in your organization? Lower management Middle management Top management

INSTRUCTIONS: Here some statements are given and for every statement you have to express your views by making a tick mark on any one of the alternatives Yes or No .Please give your response on all the items.

1)Do you work for 7 days in a week? Yes No 2) Do you work for more than 10 hours in a day? Yes 3)Do you work in night shifts? Yes No

No

4)Do you miss out the quality time with your family or friends because of your work pressure? Yes No 5)Do you feel tired or depressed because of work? Yes No 6)Have you noticed a change in your usual sleeping habits such as sleeping more,or an increased difficulty in falling or staying asleep? Yes No 7)Do you feel you have inadequate time to accomplish or balance your family and work responsibility? Yes No 8)Have you found yourself less motivated to do activities which you previously looked forward to? Yes No 9)Does your organization encourage the involvement of your family members in work achievement reward functions? Yes No 10)Does your organization have social functions at times suitable for families? Yes No 11)Are you prone to frequent head aches? Yes No 12)Does communication with your co-workers leave you feeling frustrated or misunderstood? Yes No 13)Are you the primary care-giver of an aging parent/loved on or having difficulty finding elder care resources? Yes No 14)Do you feel that you spend more hours than you like at work? Yes No 15)Do you feel that you spend more hours than you like at home? Yes No 16)Do you find yourself thinking about work instead of focusing on home or pleasure activities? Yes No 17)Have you given up activities you enjoy to work? Yes No 18)Do you spend as much time as you would like with your loved one? Yes No 19)Do you generally feel you are able to balance your work and family life? Yes No 20)Do you currently use any of the work like policies or programmes provided by the organization?

 Yes No 21)Does your organization encourage you to use paid and unpaid leave? Yes No 22)Does your colleagues support in balancing your work and family commitments? Yes No 23)Do any of the following help you balance your work and family commitments? (i) Flexible starting time (ii)Flexible finish time (iii)Flexible hours generally (iv)Time off for family Emergencies & events (v)Part-time or reduced Yes Yes No No Yes Yes Yes No No No

24)Do any of the following hinder you in balancing your work and family commitments? (i)Long work hours (ii)Compulsory over time (iii)Week end work (iv)Timing of work Yes Yes Yes Yes No No No No

25) Do any of the following hinder you in balance your work and family commitments? (i)Negative attitude of manager (ii)Negative attitude of colleagues (iii)Negative attitude of members Yes Yes Yes No No No