Survey Templates Social Surveys Quality of Life Survey Questions + Sample Questionnaire Template

Quality of Life Survey Questions + Sample Questionnaire Template

This quality of life survey template helps collect demographic and quality of life data from a wide range of respondents. These survey questions also collect data about an individual and society in general on various parameters like the overall quality of life, natural environment, health, housing, community, overall well-being, and community and social culture. The most effective use of this survey is for any council, government, consortium, school, or organization to collect data about the quality of life of those associated with them. According to the US News, in 2020, Canada ranks number one in quality of life.

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1. Please select your gender

Male

Female

2. What is your highest education level completed?

No schooling completed

Some high school or diploma

High school graduate

Professional/Vocational/Technical Training

Bachelor’s degree

Master’s degree

Doctorate degree

3. What is your marital status?

Single/Never married

In a committed relationship

Married

Separated

Divorced

Spouse deceased

4. What is your ethnicity?

American Indian/ Native American

Asian

African American or Black

Hispanic/Latino

White

Others

5. Please select your employment type

Student

Homemaker

Unemployed

Veteran

Salaried

Business Owner

Other

6. During the past 6 months, you have lived: (select all that is applicable)

Alone

Parents

Friends/Roommates

Children

Partner

Other

7. Please select your housing type

Apartment

Terraced

Duplex

Log Cabin

Cottage

Bungalow

Mansion

Homeless

8. Please select the most appropriate answer options

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I am happy with the house I live in	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I am satisfied with the hygiene around the house	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

My neighbors are good	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I am satisfied with the food that I eat	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I am happy with the clothes I wear	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I have a decent paying job	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I hang out with my friends quite often	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I am satisfied with my personal safety	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I pursue at least one hobby	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

I have a healthy relationship with my parents	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree

9. How important are the following aspects of your life?

	Not at all important	Slightly important	Moderately important	Very important	Extremely important
Having a good house to stay in	Not at all important	Slightly important	Moderately important	Very important	Extremely important

The way I spend my time on a regular basis	Not at all important	Slightly important	Moderately important	Very important	Extremely important

I need good food to eat	Not at all important	Slightly important	Moderately important	Very important	Extremely important

I need to mentally healthy	Not at all important	Slightly important	Moderately important	Very important	Extremely important

I need a good means of transportation	Not at all important	Slightly important	Moderately important	Very important	Extremely important

A healthy sex life	Not at all important	Slightly important	Moderately important	Very important	Extremely important

10. Which of the following would be your regular activity? Select all that is applicable

Paid employment

School/ University

Volunteer work

Unpaid Internship

Other

11. Please select Yes or No for each of the following questions.

	Yes	No
I am happy about achieving something good in the last 4 weeks.	Yes	No

I feel left out and odd with people around me	Yes	No

I am bored very easily	Yes	No

Lack of concentration in the last 4 weeks	Yes	No

Extremely restless and jumpy	Yes	No

Have put on a lot of weight in the last 6 months	Yes	No

Happy because I received compliments from family and friends	Yes	No

Depressed and unhappy	Yes	No

Particularly excited about something	Yes	No

12. How would you rate your mental health over the past 4 weeks?

Poor

Fair

Good

Very Good

Excellent

13. How would you rate your physical health over the past 4 weeks?

Poor

Fair

Good

Very Good

Excellent

14. Have you ever been for psychiatric consultation?

Never

Sometimes

Quite often

Always

15. How often do you consume alcohol?

Never

Sometimes

Quite often

Always

16. Do you use drugs or any other substance?

Yes

17. How often do you consume drugs?

Never

Only casually

Sometimes

Quite often

Always

18. How often does lack of money keep you from doing the things you wish to do?

Never

Sometimes

Quite often

Always

19. Please select all the activities you have done in the past 4 weeks

Gone to a restaurant with family or friends

Gone for a long drive alone or with friends

Cleaned my room/apartment/house

Gone shopping

Made a meal for self

Done my laundry

20. How important are the following factors in determining your quality of life?

	Not at all important	Slightly important	Moderately important	Very important	Extremely important
Work/school	Not at all important	Slightly important	Moderately important	Very important	Extremely important

How you feel about yourself	Not at all important	Slightly important	Moderately important	Very important	Extremely important

Your physical state of being	Not at all important	Slightly important	Moderately important	Very important	Extremely important

Your mental state of being	Not at all important	Slightly important	Moderately important	Very important	Extremely important

Your family/ friends	Not at all important	Slightly important	Moderately important	Very important	Extremely important

Your bank balance	Not at all important	Slightly important	Moderately important	Very important	Extremely important

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Top 3 reasons to use this quality of life survey template

1. Collect feedback on people's quality of life: This quality of life survey questionnaire helps collect feedback about the individual well being and measure the respondent's happiness level.

2. Evaluate the essential aspects of an individual's life: This targeted questionnaire helps gather information on various essential aspects of the respondent's daily life, which includes food, house, transportation, activities, job, safety, relationship, health, and much more.

3. General research to collect insights: This survey template is effectively used by the council, government, school, or organization for the market research study that contributes to a healthy quality of life.

Quality of Life Survey Questions + Sample Questionnaire Template

Top 3 reasons to use this quality of life survey template

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