Name:
Email Address:
1. Are you willing to continue working from home?
YesNoMaybe

2. Can your job be effectively performed from a remote environment (Home/Co-working/Cafe)?
YesNoNot Sure

3. What is your average commute time from home to office and back (total travel time)?
0-1hr1hr-2hrs2hrs-3hrs3hrs-4hrs

4. Do you have a dedicated area at home where you work from without distractions?
YesNo

5. Do you have a comfortable desk & an ergonomic task chair at home?
YesNo

6. Do you have a fast, reliable and uninterrupted internet connection to work at home?
YesNo

7. Is the necessary hardware that is required for your job available to you to operate from home?
a) Work machine – Laptop or Desktop
YesNoNA

b) Ancillary items like headphones, printer/scanner, desk phone (for BPO setup), etc.
YesNoNAA Few, Not all

8. Do you have all the necessary tools and technology in place to efficiently work from home?
YesNo

9. What's the estimated amount of money you're saving monthly while working from home ? (E.g. commute costs, lunch, etc)
0-10001000-30003000-50005000-1000010000+

For each of the below statements, please select the response that closely resonates with you.

10. I have the self-discipline to work efficiently in a remote setting (Home/Co-working/Cafe)
Strongly AgreeAgreeNeutralDisagreeStrongly DIsagree

11. I am able to structure my work responsibilities and complete them in a time bound manner while working from home
Strongly AgreeAgreeNeutralDisagreeStrongly DIsagree

12. I have better work-life balance while working from home instead of the office
Strongly AgreeAgreeNeutralDisagreeStrongly DIsagree

13. I will be successful in working from home if the right infrastructure is provided to me
Strongly AgreeAgreeNeutralDisagreeStrongly DIsagree

14. What do you see as your biggest challenge while working from home?
Productivity lossProfessional GrowthIsolationWork-life balanceTechnology ChallengesOther

15. Do you require a virtual assistant at home who could help manage your calls and schedule?
YesNoMaybe

16. How many times in a month your business-related tasks require you to go outside?
Not at all1-3 times/week4-10 times/weekMore than that

17. Do you have Health Insurance?
YesNo

18. Would you be interested in getting Health Insurance as part of Co-working Membership?
YesNo

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