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 Name of Employee
 
 
 
 
Organisation Name
 
 
 
 
 
 
Designation/ Job title:
 
 
 
Gender
 
Male
 
Female
 
 
 
Highest Qualification
 
Post Graduate
 
Graduate
 
12th
 
 
 
 For how long have you been working with this
organization?
 
1. Less than 3 months
 
2. 3 months to 1 year
 
3. Between 1 -2 years
 
4. Between 2-4 years
 
5. More than 4 years
 
 
 
Are
you a 
 
Full time employee
 
Part time employee
 
Any other please specify_________________
 
 
 
How many days in a week do you normally work?
 
Less than 5 days
 
5 days
 
6 days
 
7 days
 
 
 
On an average, how many hours in a day do you
work?
 
Less than 7 hours
 
7-8 hours
 
8-9 hours
 
9-10 hrs
 
10-12 hrs
 
More than 12 hrs
 
 
 

In an average week, how many hours of overtime
or unpaid job-related work



do you do?
 
None
 
Up to 1 hour
 
1-3 hours
 
Between 3 and 5 hours
 
More than 5 hours
 
Don’t know/can’t remember
 
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