Image Border - Irish Business and employers confederation
Image Border - Irish Business and employers confederation
Image Border - Irish Business and employers confederation
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Appendix 4:<br />
Sample Employee Childcare<br />
Needs Questionnaire 4<br />
General Directions<br />
PART I: DEMOGRAPHIC INFORMATION<br />
1. What is your gender?<br />
❑ Female<br />
Male<br />
❑<br />
2. What is your age:<br />
25 years or under<br />
26 - 30 years<br />
31 - 35 years<br />
35 - 40 years<br />
41 - 45 years<br />
45 years or over<br />
❑<br />
❑<br />
❑<br />
❑<br />
❑<br />
❑<br />
3. What is your home postcode?<br />
a.Child #1 (youngest)<br />
❑ Under 1 Year ❑ 1 - 2 Years<br />
❑ 2 - 3 Years ❑ 3 - 5 Years ❑ 6 - 12 Years<br />
Where your child receives care (Check all that apply.)<br />
❑ Nursery or crèche<br />
❑ Nanny in my home<br />
❑ Childminder in their home<br />
❑ Partner in my home<br />
❑ Another family member<br />
❑ Before/After School Programme<br />
❑ Nursery (attached to prep school)<br />
❑ Nursery (attached to primary school)<br />
Other (Please specify)<br />
❑<br />
________________________________________________<br />
Average Weekly Cost ______________________ per week<br />
How satisfied are you with the care? (Check one)<br />
Very dissatisfied ❑ Dissatisfied<br />
❑<br />
❑ Mixed feelings ❑ Satisfied ❑ Very satisfied<br />
_________________________________________________<br />
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