Questionnaire on work life balance

We are keen explore whether there are any particular issues for employees
responsibilities within this organization. We want to find out what we are doing well in
assist employees balance their work and family life and how we could improve.
Thank you for your help.
NAME
DEPARTMENT: ..
Please tick the Most Appropriate Options:1. Male [ ]

Female [

2. Age Group
Under 30 year
31 to 40 years
Over 40 years
4.

3. Martial Status
[ ]
[ ]
[ ]

How many children do you have?

None [ ] 1 [ ]
2[ ]
3[ ]

Married
Unmarried

More than 3 [

[ ]
[ ]

5. How old are your children?

Under 2 years
[ ]
2-5 years
[ ]
6-10 years
[ ]
11-14 years
[ ]
15-18 years
[ ]
6. Factors making Work Life Balance harder.
Lot
A
No
Doesnt
Harder Little
Difference apply to my
Harder
job

Sr.
1
2
3
4
5

Deadlines and schedules

Type of work you do
No. of hours you need to work
Expectations/attitude of supervisor or
mgr
Expectations/attitude of work males

6
7
8

How easy/ difficult it is to take leave

Amt. of notice you get about the
hours/overtime you need to work
Having to take additional work home

9
10
11
12

Amount of travel required

Times meeting/training are scheduled
Starting and finishing time
Flexible timings

7. How big an impact work has on work life balance?

Sr.
No
1
2
3
4
5
6
7

Often Rarely

Dont
know

Sometimes Never

Spending time with friends

Get home on time
Do any study or training you
want to do
Take care of personal
business
Keep healthy and fit, play
sports other leisure activities
Take part in community
activities or fulfill religious
commitments
Take care of family ad spend
time with them

8 Do you generally feel you are able to balance your work and family life?
Yes

[ ]

No [ ]

9 Do you believe that your superiors style support your work life balance?
Sometimes [ ]

Always [ ]

Rarely [ ]

10 Can you openly discuss issues related to your work life with your superior?
Yes, all the time
Yes, sometimes
Depends on the matter
Not at all

[
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No response

[ ]

11. Please tick the most appropriate option on statements on work life balance.
Sr.
1
2
3

Strongly
Agree

Agree

Disagree

Strongly
Disagree

WLB enables people to

work better
WLB entirely
employers , partly
individuals responsibility
WLB is entirely an
employers responsibility

12. Please tick if you have any of the responsibilities as primary career?
a.
b.
c.
d.
e.
f.

Child care
Elder care
Caring for sick child
Caring for disable adult
Caring for sick adult
Caring for disabled

[
[
[
[
[
[

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]

13. How much time do you spent on the following activities in a working day (in
percentage)?
Office
Hobbies
Household activities
Study
Care
14. Please tick the following services, which you have used?
a. Medical facilities
b. Educational allowance
c. Holiday pay scheme

[
[
[

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]

15. What could this organization do to help you balance your work and family life?

16. I am very busy and impatient.

Always [ ]

Often [

Sometimes [ ]

Rarely [ ]

Never [ ]

Sometimes [ ]

Rarely [ ]

Never [ ]

17. I get angry on a frequent basis.

Always [ ]

Often [

18. I have to cope with too many organizational or job task changes.
Always [ ]

Often [

Sometimes [ ]

Rarely [ ]

Never [ ]

19. I feel pressured by too many demands from clients/customers /boss.

Always [ ]

Often [

Sometimes [ ]

Rarely [ ]

Never [ ]

Rarely [ ]

Never [ ]

Rarely [ ]

Never [ ]

20. I dislike turning over responsibility to others.

Always [ ]

Often [

Sometimes [ ]

21. Worry robs me of time and energy.

Always [ ]

Often [

Sometimes [ ]

22. I put things off until it's too late, or no longer matters.
Always [ ]

Often [

Sometimes [ ]

Rarely [ ]

Never [ ]

Rarely [ ]

Never [ ]

23. Planning my day-every day is difficult for me.

Always [ ]

Often [

Sometimes [ ]

24. I am unable to establish a clear direction and develop personal and career goals.

Always [ ]

Often [

Sometimes [ ]

Rarely [ ]

Never [ ]

25. I find it difficult to create a health work and life balance.

Always [ ]

Often [

Thank you for your time

Sometimes [ ]

Rarely [ ]

Never [ ]