Questionnaire
Dear Participant
You are invited to participate in this WORK LIFE BALANCE survey. Aim of this questionnaire is to study
determinants and their effects on work and personal life of employees. The information provided by you will
be kept confidential and used for the research purpose.
Name: Click here to enter text. Age: Choose Select age Group
Gender: Choose an item.
Name of Organization: Click here to enter text.
Job Title: Click here to enter text.
1. How many hours in a week do you normally work? (Please write in space provided against each category)
Standard Paid Extra hours
hours Click here Hrs. overtime Click here Hrs. without pay Click here Hrs.
2. Do you normally work any hours outside the ‘usual’ working week?
(Early mornings before 8am, evenings after 5pm or weekend work)
3. What factors do you consider while looking for a job?
Not Important Quite Important Important Very Important Not Applicable
Salary/Wages
Location of workplace
Holidays
Interest in job
Career development
prospect
Flexible working Hours
Leave Arrangement (Casual,
Academic, Sick, Maternity/Parental etc.)
Training opportunities
Job security
Friendly Environment
4. How do you rate your current job in following parameters?
Poor Satisfactory Good Very Good Not Applicable
Salary / Wages
Location of workplace
Holidays
Interest in job
Career development
prospect
Flexible working Hours
Leave Arrangement (Casual,
Academic, Sick, Maternity/Parental etc.)
Training opportunities
Job security
Friendly People
5. Overall, how satisfied would you say you are with your job?
6. Are you currently living with a spouse or partner?
7. Do you have any children living at home with you? If yes how many.
No. of Children Click here to enter text.
8. Do you look after, or provide any regular care or help for any sick, elderly or disabled adults?
9. To what extent does your family life and family responsibilities interfere with your performance on your job
in any of the following ways?
Strongly Agree Agree Neutral Disagree Strongly Disagree
Family matters reduce the time
you can devote to your job
Family worries or problems
distract you from your work
Family activities stop you getting
the amount of sleep you need to do
your job well
Family obligations reduce the time
you need to relax or be by yourself
10. To what extent do your job responsibilities interfere with your family life in the following ways?
Strongly Agree Agree Neutral Disagree Strongly Disagree
Your job reduces the amount of
time you can spend with the family
Problems at work make you
irritable at home.
Your work involves a lot of time
away from home
Your job takes up so much energy
you don’t feel up to doing things
that need attention at home
11. Does your organization have policy for “work life balance?
12. Work life balance policies applied in same way at all levels of management in your organization or it covers
all levels in hierarchy.
13. Your organization encourages involvements of employee’s family members in work/organization’s
celebrations or organization arrange occasions/functions where employee’s family members can participate.
14. Employees are expected to put their jobs before family and personal matter.
15. Do you have any suggestion about ‘work life balance’?
In other words, how happy you are with the way you divide your life up between work, family, caring for others and
leisure? (Please give your answer in following box)
Click here to enter text.
Please save the file and send back to sourabhmunjal0112@gmail.com as attached file.
Thank You for Your valuable time and Patience
Wish you happy work life!!
