1. Age:

2. Gender : Male/ Female

3. Designation:

4. Nature of Organisation:

5. Experience:

6. Level in management

a. Junior level b. Middle level c. Senior level

7. How many days in a week you normally work:

a. Less than 5 days b. 5 days c. 6 days d. 7 days

8. How many hours in a week you normally work:

a. 7-8 hours b.8-9 hours c. 9-10 hours d.10-12 hours e. more than 12 hours

9. How many hours a day do you spend while travelling to work:

a.> 30 min b. nearly 1 hour c. nearly 2 hours d. <2 hours

10. How often do you think or worry about work (when you are not actually at work or

traveling to work)?

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

11. Do you work in shifts:

a. General shift/day shift b. Night Shift c. Alternative shift

12. Are you married:

a. Yes b. No

13. If yes, is your spouse employed:

a. Yes b. No

14. Do you have children?

a. Yes, No. of children b. No

15. Being and employed women who takes care of your children:

a. Spouse b. In-Laws c. Parents d. Servants e. baby care centres

16. From the following tick/underline the factor that motivates you to work.

a. Personal satisfaction

b. Financial independence

c. Support from family

d. Utilization of time

e. Others (please specify)

17. How do you feel about the amount of time you spent at work:

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

18. Do you ever feel tired or depressed about your work:

a. Never b. Rarely c. Sometime d. Often e. Always19. Do you ever miss out on any quality time with your family or your friends because of

pressure of work?a. Never b. Rarely c. Sometime d. Often e. Always

20. Is your ability to achieve your desired balance between work and life ever a source of

personal stress, worry or ill health? ___________

21. When you want to can you easily take time off to attend ‘home’ events like school sports

days and birthdays etc.?

a. Never b. Rarely c. Sometime d. Often e. Always22. Do you have the time and energy to fulfill your responsibilities outside of work to your

satisfaction?a. Never b. Rarely c. Sometime d. Often e. Always

23. Does your partner or children ever complain that you don’t have enough quality time for them?a. Never b. Rarely c. Sometime d. Often e. Always

24. How do you manage stress arising from your work?a.Yoga B. Meditation c. Entertainment (specify_______)e. Others (specify_______)

25. Does your company have a separate policy for work life?a. Yes ( specify____________________________________________________)b. No

26. How the following factors hinder or affect you in balancing your work and family commitments?

Factors Never Rarely Sometime Often Always

Hours of workOvertimeNeed to work on holidayWork from home after office hoursTravelling away from homeNegative attitude of supervisorsNegative attitude of colleaguesNegative attitude of spouse/ family

27. Do you suffer from any stress related disease?a. Hypertension b. Obesityc. Diabetesd. Frequent headachee. Nonef. Others (specify__________)28. Do you feel work life balance policy in the organization should be customized to

individual needs?a. Strongly agree b. Agreec. Indifferentd. Disagreee. Strongly disagree

29. Rank according to their importance the following factors which will help you in your work-life balance:Factors RankMore flexible working hoursWork from homeTime off for family emergency & eventsJob sharingSupport from superior and colleaguesSupport from family and spouses

30. Do you think a better work life balance of employees can make the organization more effective and successful?