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Survey Templates Surveys study

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study


Hello:
You are invited to participate in our survey. In this survey, approximately 1000 people will be asked to complete a survey that asks questions about your work and family lives. It will take approximately 60 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Jane Wu by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

Background Information
Age
Gender
Race
Highest level of education:
Number of years you have been with your spouse or significant other
Number of elderly under your care
Number of children
Age of youngest child
Please indicate the extent to which you agree or disagree with the following statements.
Being a parent earns me certain rights and privileges that otherwise I could not enjoy
Being a parent results in rewards that would be difficult to achieve elsewhere
Being a parent offers many unique benefits that make any drawback seem insignificant
Being a parent gives me support so I can face the difficulties of work
Being a parent makes disappointments on the job seem easier to take
Being a parent helps me forget the problems at work
Being a parent energizes me so I can tackle the challenges of my job
Being a parent gives me access to certain facts and information which could be used at work
Being a parent improves my image at work
Being a parent provides me with contacts who are helpful for my work
Being a parent helps me be seen as a valuable employee by my company
Being a parent develops skills for me that are useful at work
Being a parent helps me understand the people at work better
Being a parent shows me ways of seeing things that are helpful at work
Being a parent gives me ideas that can be applied on the job
Being a parent demands time from me that could be spent on my job
Being a parent produces tensions and anxieties that decrease my performance at work
Being a parent creates worries that make concentration at work difficult
Being a parent makes me so irritable that I take it out on the people at work
Being a parent tires me out so I feel drained for work
Being a parent makes me behave in ways which are unacceptable at work
Being a parent makes it hard to adjust back to the way I must act at work
Being a parent creates difficulties for me since I must behave so differently at work
Please indicate the extent to which you agree or disagree with the following statements.
Being involved in the community earns me certain rights and privileges that otherwise I could not enjoy
Being involved in the community earns me certain rights and privileges that otherwise I could not enjoy
Being involved in the community results in rewards that would be difficult to achieve elsewhere
Being involved in the community offers many unique benefits that make any drawback seem insignificant
Being involved in the community gives me support so I can face the difficulties of work
Being involved in the community makes disappointments on the job seem easier to take
Being involved in the community helps me forget the problems at work
Being involved in the community energizes me so I can tackle the challenges of my job
Being involved in the community gives me access to certain facts and information which could be used at work
Being involved in the community improves my image at work
Being involved in the community provides me with contacts who are helpful for my work
Being involved in the community helps me be seen as a valuable employee by my company
Being involved in the community develops skills for me that are useful at work
Being involved in the community helps me understand the people at work better
Being involved in the community shows me ways of seeing things that are helpful at work
Being involved in the community gives me ideas that can be applied on the job
Being involved in the community shows me ways of seeing things that are helpful at work
Being involved in the community demands time from me that could be spent on my job
Being involved in the community produces tension and anxieties that decrease my performance at work
Being involved in the community makes me so irritable that I take it out on the people at work
Being involved in the community tires me out so I feel drained for work
Being involved in the community makes me behave in ways which are unacceptable at work
Being involved in the community makes it hard to adjust back to the way I must act at work
Being involved in the community creates difficulties for me since I must behave so differently at work
Please indicate the extent to which you agree or disagree with the following statements.
Being involved in recreation/hobby groups earns me certain rights and privileges that otherwise I could not enjoy
Being involved in recreation/hobby groups results in rewards that would be difficult to achieve elsewhere
Being involved in recreation/ hobby groups offers many unique benefits that make any drawback seem insignificant
Being involved in recreation/hobby groups gives me support so I can face the difficulties of work
Being involved in recreation/hobby groups makes disappointments on the job seem easier to take
Being involved in recreation/hobby groups helps me forget the problems at work
Being involved in recreation/hobby groups energizes me so I can tackle the challenges of my job
Being involved in recreation/hobby groups gives me access to certain facts and information which could be used at work
Being involved in recreation/hobby groups improves my image at work
Being involved in recreation/hobby groups provides me with contacts who are helpful for my work
Being involved in recreation/hobby groups helps me be seen as a valuable employee by my company
Being involved in recreation/hobby groups develops skills for me that are useful at work
Being involved in recreation/hobby groups helps me understand the people at work better
Being involved in recreation/hobby groups shows me ways of seeing things that are helpful at work
Being involved in recreation/hobby groups give me ideas that can be applied on the job
Being involved in recreation/hobby groups demands time from me that could be spent on my job
Being involved in recreation/hobby groups produces tensions and anxieties that decrease my performance at work
Being involved in recreation/hobby groups makes me so irritable that I take it out on the people at work
Being involved in recreation/hobby groups creates worries that make concentration at work difficult
Being involved in recreation/hobby groups tires me out so I feel drained for work
Being involved in recreation/hobby groups makes me behave in ways which are unacceptable at work
Being involved in recreation/hobby groups makes it hard to adjust back to he way I must act at work
Being involved in recreation/hobby groups creates difficulties for me since I must behave so differently at work
Please indicate the extent to which you agree or disagree with the following statements.
My work schedule often conflicts with my family life
After work, I come home too tired to do some of the things I'd like to do
On the job I have so much work to do that it takes away from my personal interests
My work takes up time that I'd like to spend with my family
Because my work is demanding, at times I am irritable at home
My family dislikes how often I am preoccupied with my work while I am at home
The demands of my job make it difficult to be relaxed all the time at home
My job makes it difficult to be the kind of spouse or parent I'd like to be
At work I have to do things that should be done differently
At work I am not able to be myself
On the job I work under incompatible policies and guidelines
My job offers too little opportunity to acquire new knowledge and skills
I would like to have more power and influence over other people at work
At work I receive an assignment without adequate resources to complete it
Where I work I am not able to act the same regardless of whom I'm dealing with
At work I receive incompatible requests from two or more people
My family does not enjoy doing some of the things I'd like to do
My spouse and I have different ideas about who our friends should be
Because of my family situation, I have too little time to pursue my personal interests
My family responsibilities force me to do things I rather not do
My spouse and I have different ideas about spending time with relatives
My spouse and I have different preferences with respect to entertainment
My spouse and I differ about spending time alone
My spouse and I have different goals for us as a couple
Please indicate the extent to which you agree or disagree with the following statements.
After work, I come home too tired to do some of the things I'd like to do
On the job I have so much work to do that it takes away from my personal interests
My family/friends dislike how often I am preoccupied with my work while I am at home
My work takes up time that I'd like to spend with family/friends
I am often too tired at work because of things I have to do at home
My personal demands are so great that it takes away from my work
My superiors and peers dislike how often I am preoccupied with my personal life while at work
My personal life takes up time that I'd like to spend at work
Please indicate how often the following events generally occur in your life.
How often does your job or career interfere with your responsibilities at home, such as yard work, cooking, cleaning, repairs, shopping, paying the bills, or child care?
How often does your job or career keep you from spending the amount of time you would like to spend with your family?
How often does your home life interfere with your responsibilities at work, such as getting to work on time, accomplishing daily tasks, or working overtime?
How often does your home life keep you from spending the amount of time you would like to spend on job or career-related activities?
Please indicate the extent to which you agree or disagree with the following statements.
The demands of my work interfere with my home and family life
The amount of time my job takes up makes it difficult to fulfill family responsibilities
Things I want to do at home do not get done because of the demands my job puts on me
My job produces strain that makes it difficult to fulfill family duties
Due to work-related duties, I have to make changes to my plans for family activities
The demands of my family or spouse/partner interfere with work-related activities
I have to put off doing things at work because of demands on my time at work
Things I want to do at work don't get done because of the demands of my family or spouse/partner
My home life interferes with my responsibilities at work such as getting used to work on time, accomplishing daily tasks, and working overtime
Family-related strain interferes with my ability to perform job-related duties
Please indicate the extent to which you agree or disagree with the following statements.
My work keeps me from my family activities more than I would like
The time I must devote to my job keeps me from participating equally in household responsibilities and activities
I have to miss family activities due to the amount of time I must spend on work responsibilities
The time I spend on family responsibilities often interfere with my work responsibilities
The time I spend with my family often causes me not to spend time in activities at work that could be helpful to my career
I have to miss work activities due to the amount of time I must spend on family responsibilities
When I get home from work I am often too frazzled to participate in family activities/responsibilities
I am often so emotionally drained when I get home I am too stressed to do the things I enjoy
Due to all the pressures at work, sometimes when I come home I am too stressed to do the things I enjoy
Due to stress at home, I am often preoccupied with family matters at work
Because I am often stressed from family responsibilities, I have a hard time concentrating on my work
Tension and anxiety from my family life often weakens my ability to do my job
The problem-solving behaviors I use in my job are not effective in resolving problems at home
Behavior that is effective and necessary for me at work would be counterproductive at home
The behaviors I perform that make me effective at work do not help me to be a better parent and spouse
The behaviors that work for me at home do not seem to be effective at work
Behavior that is effective and necessary for me at home would be counterproductive at work
The problem-solving behavior that work for me at home does not seem to be as useful at work
Please indicate the frequency with which you experience the following statements
My job makes me feel too tired to do things that need attention at home
Stress at work makes me irritable at work
My job worries me pr problems distract me when I am at home
My job reduces the effort I can give to activities at home
Personal or family worries and problems distract me when I am at home
Stress at home makes me irritable at work
Activities and chores at home prevent me from getting the amount of sleep I need to do my job well
Responsibilities at home reduce the effort I can devote to my job
Having a good day at my job makes me a better companion when I get home
The things I do at work help me deal with personal and practical issues at home
The things I do at work make me a more interesting person at home
The skills I use on my job are useful for things I have to do at home
The love and respect I get at home makes me feel confident about myself at work
My home life helps me relax and feel ready for the next day's work
Talking with someone at home helps me deal with problems at work
Providing for what I needed at home makes me work harder at my job
Please indicate the extent to which you have felt the following within the past year.
Your job reduces the effort you can give to activities at home
Stress at work makes you irritable at home
Your job makes you feel too tired to do the things that need attention at home
Job worries or problems distract you when you are at home
The things you do at work help you deal with personal and practical issues at home
The things you do at work make you a more interesting person at home
Having a good day on your job makes you a better companion when you get home
The skills you use on your job are useful for things you have to do at home
Responsibilities at home reduce the effort you can devote to your job
Personal of family worries and problems distract you when you are at work
Activities and chores at home prevent you from getting the amount of sleep you need to do your job well
Stress at home makes you irritable at work
Talking with someone at home helps you deal with problems at work
Providing for what is needed at home makes you work harder at your job
The love and respect you get at home makes you feel confident about yourself at work
Your home life helps you relax and feel ready for the next day's work
Please indicate the extent to which you believe the following statements are important or unimportant to you.
You will have good friends that you can count on
You will have people who care about you and are supportive
You will know people that you can have fun with
You will have a couple of good friends that you can talk to about personal things
You will share your life with someone you love
You will be married to one person for life
You will have children
You will buy things just because you want them
You will be financially successful
You will be your own boss
You will have a job with high social status
You will have a job that pays well
Please indicate the extent to which you agree or disagree with the following statements.
I am thinking about leaving this organization
I am planning to look for a new job
I intend to ask people about new job opportunities
I don't plan to be in this organization much longer
Please indicate the extent to which you agree or disagree with the following statements

The most important things that happen in life involve work
Work is something people should get involved in most of the time
Work should be only al small part of one's life
Work should be considered central to life
In my view, an individuals' personal life goals should be work-oriented
Life is worth living only when people get absorbed in work
Please indicate the extent to which you agree or disagree with the following statements.
The most important thing that happens in life involves the family
People should get involved in the family
The family should be a large part of one's life
The family should be considered central to life
An individual's life goals should be mainly family oriented
Life is worth living only when people get totally absorbed in family life
Please indicate the extent to which you agree or disagree with the following statements
I find real enjoyment in my job
I like my job better than the average person does
I am seldom bored with my job
I would not consider taking another kind of job
Most days I am enthusiastic about my job
I feel fairly well-satisfied with my job
Please indicate the extent to which you agree or disagree with the following statements.
I frequently think I would like to leave my family
Generally speaking, I am very satisfied with my family situation
I am generally satisfied with the responsibilities associated with my family
Below are a number of statements that describe different feelings that you may feel at work.
Please indicate how often, in the past 30 workdays, you have felt each of the following feelings:
I feel tired
I have no energy for going to work in the morning
I feel physically drained
I feel fed up
I feel like my "batteries" are "dead"
I feel burned out
I am too tired to think clearly
My thinking process is slow
I have difficulty concentrating
I feel I'm not thinking clearly
I feel I'm not focused in my thinking
I have difficulty thinking about complex things
I feel I am unable to be sensitive to the needs of coworkers and/or customers
I feel I am not capable of investing emotionally in coworkers and/ customers
I feel I am not capable of being sympathetic to coworkers and/ customers
I feel emotionally drained
Please indicate the extent to which you agree or disagree with the following statements:
It is just as important to educate daughters as it its to educate sons
Women should be more concerned with clothing and appearance than men
Women should have as much sexual freedom as men
The man should be more responsible for the economic support of the family than the woman
The belief that women cannot make as good supervisors or executives as men is a myth
The word "obey" should be removed from wedding vows
Ultimately a woman should submit to her husband's decision
Some equality in marriage is good, but by large the husband ought to have the main say-so in family matters
Having a job is just as important for a wife as it is her husband
In groups that have both male and female members, it is more appropriate that leadership positions be held by males
I would not allow my son to play with dolls
Having a challenging job or careers is as important as being a wife and mother
Men make better leaders
Almost any women is better off in her home than in a job or profession
A woman's place is in the home
The role of teaching in the elementary schools belongs to women
The changing of diapers is the responsibility of both parents
Men who cry have weak character
A man who has chosen to stay at home and be a house-husband is not less masculine
As head of household, the father should have the final authority over the children
Please indicate the frequency with which you have experienced the following statements
Have you or your husband/wife ever seriously suggested the idea of divorce within the last three (3) years?
Have you discussed divorce or separation with a close friend?

Even people who get along quite well with their spouse sometimes wonder whether their marriage is working out. Have you ever thought your marriage might be in trouble?
Did you talk about consulting an attorney?
Has the thought of getting a divorce or separation crossed your mind in the past three (3) years?
Please indicate the level of importance or unimportance of the following statements.
You will have good friends that you can count on
You will have people who care about you and are supportive
You will know people that you can have fun with
You will have a couple of good friends that you can talk to about personal things
You will share your life with someone you love
You will be married to one person for life
You will have children
You will buy things just because you want them
You will be financially successful
You will be your own boss
You will have a job with high social status
You will have a job that pays well

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