1. Questionnaire on Work Life Balance for Working Parents:
Name: Age:
Education : Family Type : Joint / Nuclear :
Do you Have Children: If Yes, then No. of children :
Q1. Are you satisfy with working hours and is it fits with your private life ?
Strongly Satisfied
Satisfied
Neutral
Dissatisfied
Strongly Dissatisfied
Q2. Do you feel that you are able to balance your work life?
Yes
No
Q3. How much time you spend on domestic activities?
Less than 2 hours
2-4 hours
4-6 hours
More than 6 hours
Q4. Do you work for long hours or overtime and even on holidays?
Frequently
Sometimes
Occasionally
Rarely
Never
Q5. How often do you think or worry about work (when you are not actually at work)?
Frequently
Sometimes
Occasionally

2. Rarely
Never
Q6. Do you usually miss out quality time with your family and friends because of
pressure of work?
Frequently
Sometimes
Occasionally
Rarely
Never
Q7. Does your organization take any initiatives to manage work life of its employees?
 Provide Flexible Work timings
 Provide Leaves to manage work life
 Provide Job share option
 Allow work from home
Q8. Do you suffer from stress related diseases like hypertension etc. or do you engage
yourself in stress relieving programs?
Yes
No
Q9. How following factors affects you in balancing your work life and family commitments?
Factors Doesn’t
Affects
Affects
Sometimes
Affects
Many times
Always
affects
Work Hours
Overtime
Work from home after
office hours
Work on holidays
Travelling away from
home

3. Excessive household
work
Negative Attitude of
family/ spouse
Negative Attitude of
supervisor/ colleagues
Q10. Rank according to your Importance in balancing work life:
Factors Rank
More Flexible hours
Work from home
Time off during school holidays
Time off during emergencies & events
Support from family members
Support from supervisor/colleagues
Q11. Tick the factor that motivate you to work:
Personal Satisfaction
Financial Independence
Support from Family
Constructive Utilization of Time
Any other : Specify :