http://wlb.rutnet.co.uk/pp/gold/viewgold.asp?

id=1389

website with all info on work life balance

Work life balance (QLB) questionnaire

1) Age:

2) Gender: Male/ Female

3) Designation:

4) Nature of Org:

5) How many days in a week do you normally work?

a) Less than 5 days

b) 5 days
c) 6 days
d) 7 days

6) How many hours in a day do you normally work?

a) 7-8 hours
b) 8-9 hours
c) 9-10 hours
d) 10-12 hours
e) More than 12 hours

7) 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) More than two hours

Do you generally feel you are able to balance your work life?

a) Yes
b) No
9) How often do you think or worry about work (when you are not actually at work or traveling
to work)?

a) Never think about work

b) Rarely
c) Sometimes
d) Often
e) Always

10) Do you work in shifts?

a) General shift/day shift

b) Night shift
c) Alternative

11) Are you married?

a) Yes
b) No

If yes, is your partner employed?

a) Yes
b) No

12) Do you have children?

a) Yes, no. of children____________.

b) No

Being an employed man/woman who is helping you to take care of your children?

a) Spouse
b) In-laws
c) Parents
d) Servants
e) Crèche/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) 4-5 hours
e) More than 5 hours
Do you regularly meet your child/children teachers to know how your child is progressing?

a) Once in a week
b) Once in two weeks
c) Once in month
d) Once in 6 months
e) Once in a year.

13) Do you take care of?

a) Older people
b) Dependent adults
c) Adults with disabilities
d) Children with disabilities
e) none

If yes, how many hours do you spend with them?

a) Less than 2 hours

b) 2-3 hours
c) 3-4 hours
d) 4-5 hours
e) More than 5 hours

14) How do you feel about the amount of time you spend at work?

a) Very unhappy
b) Unhappy
c) Indifferent
d) Happy
e) Very happy

15) Do you ever miss out any quality time with your family or your friends because of pressure
of work?

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

16) Do you ever feel tired or depressed because of work?

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

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

a) Yoga
b) Meditation
c) Entertainment
d) Dance
e) Music
f) Others, specify_________.

18) Does your company have a separate policy for work-life balance?

a) Yes
b) No
c) Not aware

If, yes what are the provisions under the policy?

a) Flexible starting time

b) Flexible ending time
c) Flexible hours in general

d) Holidays/ paid time-off

e) Job sharing
f) Career break/sabbaticals
g) Others, specify________

19) Do you personally feel any of the following will help you to balance your work life?

a) Flexible starting hours

b) Flexible finishing time
c) Flexible hours, in general
d) holidays/paid time offs
e) Job sharing
f) Career break/sabbaticals
g) time-off for family engagements/events
h) Others, specify_________

20) Does your organization provide you with following additional work provisions?

a) Telephone for personal use

b) Counseling services for employees
c) Health programs
d) Parenting or family support programs
e) Exercise facilities
f) Relocation facilities and choices
g) Transportation
h) Others, specify______________.

21) Does your organization encourage the involvement of your family members in work-
achievement reward functions?

a) Yes, specify the name of such program Annual Day________

b) No.

22) Does your organization have social functions at times suitable for families?

a) Yes, specify the name of such programs____________

b) No.

23) Does your organization provide you with yearly Master health check up?

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

a) Long working hours

b) Compulsory overtime

c) Shift work
d) meetings/training after office hours
e) Others, specify_________________

25) Do any of the following help you balance your work and family commitments?

a) Working from home

b) Technology like cell phones/laptops
c) Being able to bring Children to work on occasions
d) Support from colleagues at work
e) Support from family members
f) Others, specify___________.

26) Do any of the following hinder you in balancing your work and family commitments?

a) Technology such as laptops/cell phones

b) Frequently traveling away from home
c) Negative attitude of peers and colleagues at work place
d) Negative attitude of supervisors
e) Negative attitude of family members
c) Others, specify___________
a) Yes
b) No

27) Do you suffer from any stress-related disease?

a) hypertension
b) obesity
c) diabetes
d) frequent headaches
e) none
f) Others, specify______.

28) Do you take special initiatives to manage your diet?

a) Yes
b) No

What is your preference for food?

a) Carrying home made food

b) Dieting on vegetables and fruits
c) Choosing less calorific food
d) Choosing organic food
e) Food from the organizations cafeteria
f) Spicy/Junk food
g) Others, specify__________.

How often will you have refreshment drinks/snacks in a day?]

a) None
b) Once
c) Twice
d) Thrice
e) More than three times

29) Do you spend time for working out?

a) Yes
b) No

If yes, how many hours?

a) less than half an hour

b) half an hour
c) half an hour to one hour
d) more than 1 hour
Where do you usually prefer to do your workouts?

a) In your organizations health centers

b) Residence
c) Nearby Gym

d) Walking
e) Others, specify_____________.

30) Do you feel work life balance policy in the organization should be customized to individual
needs?

a) Strongly agree
b) Agree
c) Indifferent
d) Disagree
e) Strongly disagree

31) Do you think that if employees have good work-life balance the organization will be more
effective and successful?

a) Yes
b) No

If so how?