<p> Employee Wellness Interest Survey </p><p>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<insert contact name>by <insert date>. Your opinions are valuable and will be used to drive the types of wellness programs that may be offered to you in the future.</p><p>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</p><p>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</p><p>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</p><p>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</p><p>Do you work in a facility or do you work remotely?  Facility  Remote location</p><p>If available, would you access online wellness programs and videos? Yes  No</p><p>Would you be willing to share the cost of participating in these programs?  Yes  No</p>