# Employee Child Care Needs Survey Template

*Community Engagement Hub — Employer Toolkit*

*12 questions, ~5 minutes, anonymous. Announce why you're asking and when
you'll share results — response rates double when people know both.*

1. Do you have children who need care while you work? (Yes / No / Expecting)
2. Ages of children needing care: (0–2 / 3–5 / school-age needing before/after care / summer-only)
3. Who currently provides that care? (Licensed center / licensed home program / family member / patchwork / it varies weekly)
4. In the past 3 months, how often did care problems affect your work? (Never / 1–2 times / monthly / weekly+)
5. What did that look like? (Arrived late / left early / missed full day / worked distracted / used PTO / other)
6. Have care logistics ever affected a decision about shifts, hours, overtime, or promotion here? (Yes / No / Prefer not to say)
7. How far is your care from home or work? (Under 10 min / 10–25 / 25+ / no stable arrangement)
8. What's hardest about your current arrangement? (Cost / hours don't match my schedule / reliability / waitlists / distance / nothing)
9. Roughly what do you pay monthly per child? (ranges localized)
10. Which would help you most? Rank top 3: (Flexible scheduling / predictable shifts / pre-tax savings (FSA) / stipend / backup care / help finding care / reserved spots at a local program / on-site care)
11. Would you use an employer-supported spot at a nearby licensed program if available? (Definitely / maybe, depends on cost / no)
12. Anything else we should know? (open text)

**Reporting:** share aggregate results within 30 days, with the one action
you're taking first.

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*Demonstration content — adapt ranges and options to your workforce.*