Work–Life Balance Questionnaire for Women
Employees
Section A: Demographic Profile
Age Group: 20–29 30–39 40–49 50 & above☐☐☐☐
Marital Status: Single Married Divorced/Widowed☐ ☐ ☐
Number of Dependents (Children/Elders): __________
Total Work Experience (Years): __________
Nature of Job: Permanent Contract Shift-based Remote/Hybrid☐ ☐ ☐ ☐
Section B: Work Demands and Organizational Support
My workload is realistic and aligned with my role and capacity.
Scale: 1 = Strongly Disagree | 2 = Disagree | 3 = Neutral | 4 = Agree | 5 =
Strongly Agree
I have autonomy in deciding how and when I complete my work tasks.
Scale: 1 = Strongly Disagree | 2 = Disagree | 3 = Neutral | 4 = Agree | 5 =
Strongly Agree
My organization genuinely supports work–life balance, not just in policy but
in practice.
Scale: 1 = Strongly Disagree | 2 = Disagree | 3 = Neutral | 4 = Agree | 5 =
Strongly Agree
I feel psychologically safe to request flexible working arrangements.
Scale: 1 = Strongly Disagree | 2 = Disagree | 3 = Neutral | 4 = Agree | 5 =
Strongly Agree
My performance evaluation fairly considers my work–life challenges.
Scale: 1 = Strongly Disagree | 2 = Disagree | 3 = Neutral | 4 = Agree | 5 =
Strongly Agree
Section C: Family Responsibilities and Social Expectations
Household responsibilities are equitably shared among family members.
Scale: 1 = Strongly Disagree | 2 = Disagree | 3 = Neutral | 4 = Agree | 5 =
Strongly Agree
