Design a 10-question questionnaire based on your proposed research problem. The questionnaire must contain an introduction that explains the purpose, an approximate time frame for completion, and a statement on confidentiality/anonymity. There should be at most two open-ended questions.

The below questionnaire is composed of 10 questions that relate to a previous job or current job that has caused a change in your health and attitude towards that job due to the working hours.  The purpose of this survey is to gather information from a variety of employees for research that explains the effects on employees who have worked hours longer than the average and how it can damage, not just the health of an individual, but also their quality of work throughout the working day. With the information we hope to gather, this can then be reported to employers who are concerned about the health and welfare of overworked employees . The questions below should take approximately 10 minutes to complete, but please take any additional time needed to leave comments in the blank section at the end of the survey.  We guarantee that the questions you answer, and any additional comments, will be confidential and will not be shown to anyone other than those of us who need access that are conducting the research.

1.Have you had a job that had you working long hours which caused a change in your health and attitude towards that job?

2. How many hours did you typically work in a day at that job? (Circle one)

a. 8 hours  

b. less than 8 hours  

c. more than 8 hours

3. How many days during the week did you work? (Circle one)

a. 5 days

b. more than 5 days  

c. less than 5 days

4. Did you feel that your work environment was stressful? (Circle one)

a. Yes  

b. No

5. Did you feel as though you had a balance between your work life and personal life? (Circle one)

a. Yes

b. No

6. Do you feel as though your work ethic or quality was affected due to the job? (Circle one)

a. Yes

b. No

7. Did you feel as though the vacation time you were allotted was sufficient considering the amount of hours you worked? (Circle one)

a. Yes  

b. No

8. Was there any relationship ruined due to your job? (Circle one)

a. Yes  

b. No

9. Did you experience any health changes such as: weight-gain, weight-loss, increased stress, anger, depression and so forth while at this job? (Circle one)

a. Yes  

b. No

10. If there were some health problems that may have occurred because of the job can you please list and explain why you believe those health problems occurred?

Thank you for participating in our study and we want to guarantee again that the confidentiality of all the above answered questions will be kept confidential and only accessible to those who need this information while carrying out the duties of the study.

Evaluate each question that you included in the questionnaire. Explain how the question will help meet the objectives of the research. Please be specific and provide justification.

The purpose of this survey is to gather information from a variety of employees for research that explains the effects on employees who have worked hours longer than the average and how it can damage, not just the health of an individual, but also their quality of work throughout the working day.  The questions that comprise the survey were chosen to pick out both factual data as well as the subjective viewpoints of the employees.  The responses given to questions 2, 3 and 9 give objective answers to which our researchers can then categorize the remaining questions.  Once we can establish who, out of our surveyed employees, actually worked a non-traditional work schedule, we can then begin to extract their responses and see how they truly felt within these changes.  Questions 1 and 10 also give the participant the chance to speak freely about their job and the effect it had on them as they perceived it.   In addition to the employees perception, question 10 asks for specific health-related issues that began during the time of increased work.  We hope to find trends in health issues that are caused by overworking an employee to bring to the attention of the employers.