Employee Childcare Needs Survey Form
Employee Childcare Needs Survey Form: Please share your childcare needs and preferences so the organization can understand support requirements.
Which department do you work in?
*
Please Select
Human Resources
Finance
Operations
Sales
Marketing
IT
Other
How many children do you have who require childcare?
*
What are the ages of your child(ren) who require childcare? (Select all that apply)
*
Infant (0-1 year)
Toddler (1-3 years)
Preschool (3-5 years)
Elementary (5-12 years)
Teen (13+ years)
What type(s) of childcare do you currently use?
*
Family member
In-home nanny/babysitter
Daycare center
Before/after school program
Other
How satisfied are you with your current childcare arrangement?
*
Not satisfied
1
2
3
4
Very satisfied
5
1 is Not satisfied, 5 is Very satisfied
Which types of childcare support would be most helpful to you? (Select up to 3)
*
On-site childcare
Childcare subsidy/financial assistance
Backup/emergency childcare
Flexible work hours
Remote work options
Resource referrals (lists of providers, etc.)
Other
What are the biggest barriers you face in accessing reliable childcare? (Select all that apply)
*
Cost
Availability/waitlists
Location/proximity
Quality of care
Hours of operation
Other
How important is flexible work scheduling to your childcare needs?
*
Not important
1
2
3
4
Extremely important
5
1 is Not important, 5 is Extremely important
Do you have any additional comments or suggestions regarding childcare support?
If you would like to be contacted for follow-up, please provide your email (optional):
example@example.com
Submit
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