Employer Wellness

We are planning company wellness programs to help you feel better and stay healthy. In order to plan programs that best meet your needs and interests we would like your suggestions!

Please take several minutes to answer some questions about your interests. Your answers will be combined with those of other’s and reviewed to help plan programs for you. Do not sign your name.

Please complete the survey today and return it to__________. Thank you for your valuable input! Your help is important for planning successful programs. Return the completed form by _____________.

Rate your interest on a scale of 1 – 3 with one (1) being of little or no interest; two (2) being of some interest and three (3) indicating that you are very interested. Indicate your response by circling or “Xing” the number.

I’m interested in –

Participating in wellness programs before work 1 2 3

Participating in wellness programs after work 1 2 3

Participating in wellness programs during my lunch break 1 2 3

Learning healthy eating choices to lose weight 1 2 3

Sports nutrition 1 2 3

Healthier cooking 1 2 3

Assisting my children eat healthier 1 2 3

Quick, healthful meals for busy lifestyles 1 2 3

Healthy snack options 1 2 3

Learning how to quit smoking 1 2 3

Attending courses to help me quit use of tobacco cigarettes 1 2 3

Stress Mangement skills 1 2 3

Balancing work, family, and personal life 1 2 3

Time management skills 1 2 3

Participating in a starting fitness program 1 2 3

Planning time to exercise for busy people  1 2 3

Getting health information that I can peruse or watch at home 1 2 3

Learning about cancer prevention 1 2 3

Heart health options 1 2 3

CPR and First Aid 1 2 3

Team sports activities at work 1 2 3

Learning how to stretch 1 2 3

Learning how to raise intake of fruits and vegetables 1 2 3

Parenting Topics (age of kids –  ) 1 2 3

Onsite exercise classes –  walking Yoga aerobic other –  1 2 3

Health screening such as blood pressure, cholesterol, blood sugar 1 2 3