1.

Name: _______________________

2. Designation: ___________________

3. Gender: Male [ ] Female [ ]

4. Age Group:

a) Below 25 years b) 26-35 years

c) 36- 45 years d) Above 45 years

5. Marital Status

a) Married b) Unmarried

6. Experience

a) < 5 Years b) 5-10 Years c) > 10 Years

7. If married? How many children do you have?

a) None b)1 c) 2 d) 3

8. How old are your children?

a) None b) Under 2 years c) 2-5 years

d) 6-10 years e) 11-14 years f)15-18 years g) Above 18 Years

9. How many members are there in your family?

a) Less than 4 b) 4-6 c) More than 6

10. Travelling Distance

a) Less than 1 km b) 1-10 km c)11-20 km d)21-30 e) More than 30 km 67

11. As an employed woman who is helping you to take care of your children?

a) Spouse b) Parents c) Servants d) Crèche/day care centers e) others f) yourself

12. How many hours in a day do you spend with your child/children?

a)None b) Less than 2 hours c) 2-3 hours d) 4-5 hours e) More than 5 hours

13. Do you think that the following hinder you in balancing your work & family commitment?

a) Long working hours b) Compulsory overtime c) Shift work

14. If you have not done your work at the particular time? What are the alternative do you take?

a) Work extra time b) Work at home c) Overtime to finish the work

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

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

16. What do you feel about work load?

a) Relaxed b) Normal c) Burden

17. Do you work in shifts base?

a) General shift/day shift b) Night shift c) Alternative

18. Do you ever feel tired or depressed because of work?

a) Sometimes b) Rarely c) Always

19. How do you manage stress arising from your work?

a) Yoga b) Meditation c) Entertainment d) Dance e)Music

20. What factor influence for better work life balance

Particulars Strongly Agree Neutral Disagree Strongly

Agree Disagree

Flexible working hours

Flexible leave policies
Excellent Working
Environment
Clear roles and
responsibility
Good relationship with
subordinates and peers

21. Do you generally feel you are able to balance your work and family life?

a) Yes b) No

22. Do you believe that your superior support your work life balance?

a) Sometimes b) Always c) Rarely

23. Do you suffer from any stress-related disease? If yes, specify.

a) Hypertension [ ] b) Obesity [ ] c) Diabetes [ ] d) Frequent headaches[ ] e) None [ ]

24. What kind of facilitations is provided by your organization to enhance work life balance?

a) Yoga/Meditation b) Mentoring sessions c) Work from home

d) Team building exercises e) Social activity programmes

25. Suggestion if any to improve WLB______________________________________________