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Age:
   
 
 
 
Gender:
 
Male
 
Female
 
 
 
How many days in a week do you normally work?
 
Less than 5 days
 
5 days
 
6 days
 
7 days
 
 
 
How many hours in a day do you normally work?
 
7-8 hours
 
8-9 hours
 
9-10 hours
 
10-12 hours
 
More than 12 hours
 
 
 
How many hours a day do you spend traveling to work?
 
Less than half an hour
 
Nearly one hour
 
Nearly two hours
 
More than two hours
 
 
 
Do you generally feel you are able to balance your work - life?
 
Yes
 
No
 
 
 
How often do you think or worry about work (when you are not actually at work or traveling to work)?
 
Never think about work
 
Rarely
 
Sometimes
 
Often
 
Always
 
 
 
Are you married?
 
Yes
 
No
 
 
If yes, is your partner employed?
 
Yes
 
No
 
 
 
Do you have children?
 
Yes
 
No