Employee Wellness Interest Survey
As (insert company name) prepares to kick-off our employee wellness initiative we are asking for your input on your health and wellness needs and interests. Please take a few moments to complete this interest survey and return it to
Do you value your personal health and well-being and make a conscious effort to invest the time needed to take care of yourself? Yes No Somewhat Do you feel your employer should value employees’ health and well-being and make an effort to invest time, money and resources into health promotion at the workplace and the prevention of diseases and illnesses? Yes No Unsure
In which of the following programs/seminars would you participate? (Check all that apply) Back Pain Education On-Site Health Fairs Cardiovascular Fitness Parenting Skills Heart Disease Prevention Retirement Planning High Blood Pressure Management Stress Management Diabetes Awareness Self-Care Ergonomics Education Smoking Cessation Home Budgeting/Finance Stretch/Relaxation Breaks General Cancer Education Walking Clubs Nutritional Awareness Weight Management
In which of the following screenings would you participate? (Check all that apply) Blood Pressure Waist to Hip and BMI Screening Blood Sugar (Diabetes) Cholesterol Body Fat
When would you be most likely participate? (Check all that apply) Monday Spring Before Work Tuesday Summer Lunchtime Wednesday Fall After Work Thursday Winter Other, please specify Friday
Do you work in a facility or do you work remotely? Facility Remote location
If available, would you access online wellness programs and videos? Yes No
Would you be willing to share the cost of participating in these programs? Yes No