Tick Tock! Who Broke the Clock?

The Power of Work-Life Integration

An Intellectual Survey
Instructions: This survey is designed for you to evaluate the quality of your life in four major areas: Self, Family, Work, and Service. Respond to the statements
based on your experience and/or behavior in your personal and professional life. When taking this survey, focus on the bold words. Determine the importance of the bold phrase to your life quality and circle the number on the scale to indicate your answer. Next, read the complete statements in each category and determine your level of agreement as it applies to that particular statement. To score the survey, multiply your importance number times your agreement number and record your total. Add your scores in each category to obtain the subtotal of that category.

A Personal Work-Life Survey

Scale of Importance Scale of Agreement

SELF

Not Important Slightly Important Quite Important Extremely Important Strongly Disagree Disagree Neutral Agree Strongly Agree 1. I devote sufficient effort to my physical well-being.
Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

2.

I have a personal hobby that provides me with adequate relaxation. Importance 1 2 3 4 Agreement 1 2 3 4 5 Total ________ I actively embrace personal growth opportunities. Importance 1 2 3 4 Agreement 1 2 3 4 5 Total ________ I actively practice a religious and/or spiritual discipline. Importance 1 2 3 4 Agreement 1 2 3 4 5 Total ________ Overall, I feel integrated and balanced in terms of body, mind, and spirit. Importance 1 2 3 4 Agreement 1 2 3 4 5 Total ________

3.

4.

5.

SELF Subtotal ______

4-12

Interpretation _______________________

1998-2004 Innovations International and Cannonwood. All rights reserved. Do not duplicate.

Tick Tock! Who Broke the Clock? The Power of Work-Life Integration

An Intellectual Survey
A Personal Work-Life Survey
Scale of Importance Scale of Agreement

FAMILY

Not Important Slightly Important Quite Important Extremely Important Strongly Disagree Disagree Neutral Agree Strongly Agree 1. I experience quality relationship and communication with my spouse,
partner, or significant other. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

2.

I experience quality relationship and communication with other significant family members, (children, parents, in-laws, cousins, etc.) Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

3.

I devote sufficient quality time with my family to achieve balance with my work responsibilities. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

4.

I proactively resolve family conflicts, problems, or crises as they occur. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

5.

Overall, I am satisfied with both the time devoted to and the quality of my family (or interpersonal) relationships. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

FAMILY Subtotal ________

Interpretation ________________ 4-13

1998-2004 Innovations International and Cannonwood. All rights reserved. Do not duplicate.

Tick Tock! Who Broke the Clock? The Power of Work-Life Integration

An Intellectual Survey
A Personal Work-Life Survey
Scale of Importance Scale of Agreement

WORK

Not Important Slightly Important Quite Important Extremely Important Strongly Disagree Disagree Neutral Agree Strongly Agree 1. My work is personally meaningful to me.
Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

2.

I exercise maximum self-management in the performance of my job. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

3.

I am very competent for the work that I do. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

4.

I am creative and innovative as required by my work. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

5.

Overall, I am clear about my short and long-term career goals and my plan to achieve them. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

WORK Subtotal ________

Interpretation _________________

4-14

1998-2004 Innovations International and Cannonwood. All rights reserved. Do not duplicate.

Tick Tock! Who Broke the Clock? The Power of Work-Life Integration

An Intellectual Survey
A Personal Work-Life Survey
Scale of Importance Scale of Agreement

SERVICE

Not Important Slightly Important Quite Important Extremely Important Strongly Disagree Disagree Neutral Agree Strongly Agree 1. I am aware of how I would most like to contribute to society or others,
e.g., money, time, support, etc. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

2.

I devote sufficient time in service to others, e.g., community, religious, recreational, support, etc. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

3.

I feel I make a difference in the lives of others. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

4.

I contribute to societal organizations in proportion to my own monetary resources, e.g., tithing, contributions, etc. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

5.

I feel a natural desire to contribute to the welfare and well-being of others. Importance 1 Agreement 1 Total ________ 2 2 3 3 4 4 5

SERVICE Subtotal ________

Interpretation _______________ 4-15

1998-2004 Innovations International and Cannonwood. All rights reserved. Do not duplicate.

Tick Tock! Who Broke the Clock? The Power of Work-Life Integration

Debriefing Your Findings

Add the subtotal for each category to obtain a total score. Subtotals:

SELF

________

FAMILY ________ WORK ________

SERVICE ________

Total
The highest possible score in each category is 100. Evaluate each category and look to see what is working for you. Notice any gaps between how your life is at present and how you would like it to be. Read through the following descriptions and select one that best fits your overall personal evaluation for each of the four areas of your life. Only you can determine exactly what your number totals mean.

Category Description One: Fantastic! Incredible! You feel it couldnt be better! Category Description Two: Things are great and you know with a little work
the quality could get better.

Category Description Three: Things are okay but there is reason for concern.
Your life is always changing and the quality of life goes up and down.

Category Description Four: Life is a struggle the majority of the time. You
are either on your way up or on your way down. Youre just never sure which way youre moving.

Category Description Five: Life is a constant battle and you feel like youre
always losing.

Interpreting Your Score:

Choose a category description based on the analysis you made of each. The real answers for improving your life quality lie in the results of each individual statement. Go back again and pay particular attention to the statements where your results reveal a significant gap between the importance of a particular value to you and the amount of effort you put into actualizing that value.
A more in-depth analysis of this survey can be found on pages 31 through 36 in the book, Tick Tock! Who Broke the Clock?

4-16

1998-2004 Innovations International and Cannonwood. All rights reserved. Do not duplicate.