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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

  1. This self-assessment looks at how well your work and personal life fit together. Your answers help us shape policies that suit employees' needs.

  2. How often do you feel your work and personal life are in good balance?

    Choose one:

    • Always
    • Most of the time
    • Sometimes
    • Rarely
    • Never
  3. How would you rate your current work-life balance overall?

    A number from 1 to 10

  4. What does a good work-life balance look like for you?

    Open answer

Pressures and Obstacles

  1. 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
  2. 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

  3. 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
  4. Tell us more about the obstacles you selected.

    Condition: Shown when at least one obstacle was selected

    Open answer

Company Support

  1. 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
  2. What else could the company do to support your work-life balance?

    Open answer

Your Own Approach and Outlook

  1. What do you do yourself to keep work and personal life in balance?

    Open answer

  2. 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