WORK LIFE BALANCE

1. What is your age?

……………………………….

2. Gender
a) Male
b) Female

3 Your Designation

……………………………………

4. Do you spend more hours than you would like at work?

a) Yes
b) No

5. Do you spend more hours than you would like working at home?
a) Yes
b) No

If yes, how many hours do you work at home in an average week?

a) 1-4 hours
b) 5-9 hours
c) More than 10 hours

6 Are you satisfied with your work life?

a) Yes
b) No

7 Are you living your ideal life?

a) Yes
b) No

Give reason________________________
 8 How many hours a day do you spend traveling to work?
a) Less than half an hour
b) Nearly one hour
c) Nearly two hours
d) If others, specify_____________

9 Do you generally feel that you are able to balance your work &
personal life?
a) Yes
b) No

10. Do you spend time for working out?

a) Yes
b) No

11. Do you work in job shifts?

a) General shift
b) Night shift
c) Alternative

12. Marital status?

a) Married
b) Unmarried

If you are married, Is your partner employed?

a) Yes
b) No

13. Do you have children?

a) Yes
b) No
If yes, no of children__________

14. Being employed man/women who are helping to take care of your
children?
a) Spouse
b) In –laws
 c) Parents
d) Servants
e) Day care centers

How many hours in a day do you spend with your child/children?

a) Less than 2 hours
b) 2-3 hours
c) 3-4 hours
d) Other, specify

15. Do you ever miss out quality time with your family or your friends
because of work?
a) Never
b) Rarely
c) Sometimes
d) Always

16. Do you feel tired or depressed because of work?

a) Never
b) Rarely
c) Sometimes
d) Always

17. How do you manage stress arising from your work?

a) Yoga
b) Meditation
c) Dance
d) Music
e) Other, specify

18. Do any of the following hinder you in balancing your work & family
commitments?
a) Long working hours
b) Compulsory overtime
c) Shift work
d) Other, specify________________________
19. Does your organisation provide you with yearly master health check
up?
 a) Yes b) No

20. Do you suffer from any stress-related disease?

a) Hypertension
b) Diabetes
c) Frequent headache
d) Other, specify___________

21. Does your company have a separate policy of work life balance?
a) Yes
b) No
c) Not aware

If yes, what are the provisions under the policy?

a) flexible start time
b) flexible ending time
c) holiday
d) job sharing
e) career break
f) flexible hours in general
g) others, specify___________

22. Do you generally feel any of the following will help you to balance
your work life?
a) Flexible start time
b) Flexible ending time
c) Holiday
d) Job sharing
e) Career break
f) Flexible hours in general
g) Others, specify___________

23. Do you feel work life balance policy in the organisation should be
customized to individual needs?
a) Strongly agree
b) Agree
c) Indifference
 d) Disagree
e) Strongly disagree

24. Does your organisation provide you with following additional work
provisions?
a) Counseling services for employees
b) Health program
c) Exercise facilities
d) Transportation
e) Others, specify__________________

25. Do you think that if employees have good work life balance than the
organisation will be more effective and successful?
a) Yes
b) No
Give reason______________