DEMOGRAPHIC PROFILE

Name:___________________________________________________________ Age:___________

Marital Status:__________________ Department:________________________________

Blood Pressure:______________ Height: ________ Weight:________

BMI:_______________ BMI Classification:_________________

Dear Ma’am/Sir,

I wish to introduce myself; I am Mr. Mark John R. Domingo taking up my Master of Arts in Education
major in Physical Education, pursuing a research on the work life balance as well as the physical activities of the
teachers of Dona Aurora National High School. In this context I kindly request you to spare some time to answer
this questionnaire. I look forward your support and cooperation to enable me in the successful completion of my
research. The information provided will be strictly applied for academic propose only.

I.A Give your perceived life-work balance in the personal environment.

SELF-MANAGEMENT STRONGLY AGREE NUETRAL DISAGREE STRONGLY

DISAGREE DISAGREE
1 I can spend the time I want on my own self
development.
2 I have enough time to think, plan, and to schedule my
day-to-day activities.
3 I have sufficient time to take care of myself.
4 I have time and energy to engage in any leisure
activities that I want to do.
5 I have sufficient time to relax myself.
6 I undergo physical exercise regularly.

I.B Give your opinion about personal life expectations.

PERSONAL LIFE EXPECTATIONS STRONGLY AGREE NUETRAL DISAGREE STRONGLY

DISAGREE DISAGREE
1 I need to relax for a minimum of 3 hours per day.
2 I want to have a nice sleep of minimum of 8 hours at
night.
3 I want to have my breakfast in the morning without
hurry.
4 I want to have official work-free leisure hours on
weekends.
5 I want to spend quality time with myself.
6 I want to spend quality time with my family.
7 I want to spend quality time with my co-workers.
8 I want to do an exercise that is necessary for me
every day.
9 I want to engage myself in social activities at least
twice a week.
10 I want to be more cheerful.
11 I want to live an ideal life as planned.
12 I want to maintain good quality of family life
strongly built by right work-life balance.
 I.C. Give your perceived work-life balance in the work environment.

WORKLOAD STRONGLY AGREE NUETRAL DISAGREE STRONGLY

DISAGREE DISAGREE
1 My job helps me away from my family too much.
2 I feel I have more than to do than I can handle
comfortably.
3 I feel more respected because of my responsibilities
in job.
4 Coming up with new ideas to get appreciated in the
organization creates work pressure.
5 My responsibility at work increases my workload.
6 I often come home late in the evening.
7 I get disturbed when there is delay in the completion
of work.
8 I plan my work and perform orderly without any
delay.
9 I am ready to take too many tasks at full stretch.
10 I will always finish my work without pending.
11 I always prepare work schedule to fulfill both my
personal and family contentment.

II.

Given a chance to become a physically active, what activities do you want to do in your leisure time? Why?

What are the reasons why you are not that physically active?

Thank you very much for spending your precious time.