QUALITY OF WORK LIFE SURVEY

PERSONAL DATA:
1. Name :
2. Employment Number:
3. Age: • 20-30  • 31-40  • 41-50  • 51-60  • Above 60 years 
4. Sex: • Male  • Female 
5. Marital Status: • Married  • Unmarried 
6. Designation: • Supervisor  •Staff Nurse 
• ANM  •Nurse Trainee 
7. Educational Qualification: • 1 year nurse training  •ANM 
• Diploma  • B.Sc., Nursing 
8. Years of experience: • 0-5years  • 5-10 years 
• 10-15 years  • above 15 years 
9. Monthly Income: • 1000 – 4000  • 4001 – 7000 
• 7001 – 10000  • Above 10001 

PLEASE MARK [√] IN APPROPRIATE COLUMN:

SL STRONGLY STRONGLY
QUESTIONS AGREE DISAGREE
NO AGREE DISAGREE
Adequate and Fair Remuneration
I am given satisfactory salary for the work I

do
My income is enough to meet my life needs
Salary differentials is fairly calculated based

on responsibility of work
There is good linking of rewards and work

performance
Safe and Healthy Working Condition
I am provided with adequate supplies to

protect myself from Hospital infections –

Gloves, face mask etc
I have reasonable working hours and

adequate rest periods are provided to me

Physical working condition is very

comfortable – Lighting, Ventilation etc

Security and Growth Opportunities
I don’t have any fear of losing my job
My specific skills and experience are much

needed for my organization

Opportunity for growth and development
I have been given opportunity for Self

improvement and advancement

Motivation
My work environment is highly motivating

for better performance

Nature of Supervision
My supervisors are friendly at my work place
My supervisors guide me to do my job better
Application of Natural Justice and Equity
I have been given equal chance for my carrier

growth as other nurses in the organization

There is no partiality in decisions regarding

promotions and awarding pay increase

Respect at work
I feel my personal rights are protected in my

organization
There is no ill treatment of nurses by other

employees – Doctors and Superiors

Occupational Stress
My work place is stress free
Adequate time is given to complete my task
Recognition
I am recognized when I do some outstanding

performance
Autonomy and Participation
I have been given adequate freedom to carry

out my work activities

My preferences are considered when they

assign my work area

My organization gives me option to give my

suggestions and it really considers for its

implementation if reasonable
Adequacy of Resources
There is a balance between stated objectives

and resources provided

Adequate medical and surgical supplies are

available to render good nursing care

All the equipments are available in the

inpatient wards
Grievances Procedure
I know where to approach if I have any

complaint
My grievances are fairly enquired and

resolved

☤ Would you recommend this hospital to a friend as a good place to work?

• Yes 
• No 
• If no, why
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☤ What are the employee benefits provided by the hospitals?
□ Health Insurance
□ Paid Holidays
□ Retirement Plans
 □ Other Employee Benefits
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
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☤ Do you think quality of work life of the organization helps to improve your
productivity?
 Yes 
 No 

☤ Your recommendation for the organization to improve Quality of Work Life:

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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SIGNATURE :
DATE :