Name (Optional): ______________________________Unit/Department: __________________

1. How long have you been working in this company?

less than a year
1 to 4 years
5 to 10 years
more than 10 years
2. How many hours do you work per week?
less than 20 hours
20 to 30 hours
31 to 40 hours
41 to 50 hours
more than 50 hours
3. Do you usually work beyond working hours? (if YES, answer question no. 4, if NO, proceed to
no.5)
No
Yes
4. How often do you work overtime?
Daily
Weekly
Monthly
Only when needed
5. How much time do you spend on leisure activities everyday?
No time
Less than 30 minutes
30 minutes to 1 hour
More than 1 hour
6. What do you usually do after work?
Attend school
Spend time with the family
Rest
Others ___________
7. Do you feel you are not able to balance your work life?
Always
Often
Sometimes
Rarely
Never
8. Are you able to spend enough time with your family?
Always
Often
Sometimes
Rarely
 Never
9. Do you ever miss out any quality time with your family or your friends because of work?
Always
Often
Sometimes
Rarely
Never

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

Always
Often
Sometimes
Rarely
Never
11. Does your job takes up so much energy in which you don’t feel up to doing things that need
attention at home?
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
12. Are you satisfied with your current work schedule?
Yes
No
13. Do you agree on the possibility of changing the work schedule into a 4-day work week?
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
14. Would a 4-day workweek interfere with any current arrangements for you such as family care,
school, etc.?
No
Yes, Why? ____________________________________________
15. Please list potential positive impacts of a 4-day workweek schedule on your department, and
the services your department offers: ________________________________________________
______________________________________________________________________________

16. Please list potential negative impacts of a 4-day workweek schedule on your department, and
the services your department offers: ________________________________________________
______________________________________________________________________________

17. What is your primary concern about the possibility of moving to a 4-day workweek schedule?
 ______________________________________________________________________________
______________________________________________________________________________

18. What would be the direct negative effect/s to you if you have a 4-day workweek schedule?
______________________________________________________________________________
______________________________________________________________________________

19. What would be the direct benefit/s to you if you have a 4-day workweek schedule?
______________________________________________________________________________
______________________________________________________________________________
20. Please respond to the following statement: Having a 4-day workweek schedule would improve
employee’s work-life balance.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree