Questionnaire template
Work-Life Balance Self-Assessment
Employees assess their work-life balance, the pressures on it, company policy support and their own outlook.
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Questions in this template
Your Balance Today
This self-assessment looks at how well your work and personal life fit together. Your answers help us shape policies that suit employees' needs.
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How often do you feel your work and personal life are in good balance?
Choose one:
- Always
- Most of the time
- Sometimes
- Rarely
- Never
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How would you rate your current work-life balance overall?
A number from 1 to 10
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What does a good work-life balance look like for you?
Open answer
Pressures and Obstacles
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How often does each of these happen to you?
- Working overtime
- A long commute
- Inflexible working hours
- A heavy workload
For each row: choose one:
- Never
- Rarely
- Sometimes
- Often
- Always
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When it happens, how much does each one harm your work-life balance?
- Working overtime
- A long commute
- Inflexible working hours
- A heavy workload
For each row: a number from 1 to 10
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Which of these get in the way of your work-life balance? Select all that apply.
Choose any that apply:
- Not enough time
- Workplace culture
- Little support from managers
- Work messages outside working hours
- None of these
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Tell us more about the obstacles you selected.
Condition: Shown when at least one obstacle was selected
Open answer
Company Support
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How well does each of these company policies support your work-life balance?
- Flexible working hours
- Working from home
- Holiday and paid leave
For each row: choose one:
- 1 - Not at all effective
- 2
- 3
- 4
- 5 - Very effective
- Not available to me
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What else could the company do to support your work-life balance?
Open answer
Your Own Approach and Outlook
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What do you do yourself to keep work and personal life in balance?
Open answer
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Over the next year, how do you expect your work-life balance to change?
Choose one:
- Much worse
- Somewhat worse
- About the same
- Somewhat better
- Much better