WORK LIFE BALANCE QUESTIONNAIRE

Please fill in the following informations:

NAME:

AGE:

FAMILY:
MARRIED: YES
If yes, is he

NO

EMPLOYED

CHILDREN: YES

BUSINESS

NO

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

Yes

No

(ii)Flexible finish time

Yes

No

(iii)Flexible hours generally

Yes

No

(iv)Time off for family

Emergencies & events
(v)Part-time or reduced

Yes

No

Yes

No

24)Do any of the following hinder you in balancing your work and family
commitments?
(i)Long work hours

Yes

No

(ii)Compulsory over time

Yes

No

(iii)Week end work

(iv)Timing of work

Yes
Yes

No
No

25) Do any of the following hinder you in balance your work and family
commitments?
(i)Negative attitude of manager

Yes

No

(ii)Negative attitude of colleagues

Yes

No

(iii)Negative attitude of members

Yes

No