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  2. 2016
  3. November
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  5. Wellness Survey
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Exit Survey
 
 
You have been invited to take a wellness survey! This survey should take no longer than fifteen minutes and all collected responses will be anonymous. Data gathered from this survey will help your company understand their employees' current health habits and interest areas.


This survey is adapted from the Wisconsin Worksite Wellness Program, a joint venture by the Wisconsin Partnership for Activity and Nutrition - Business Subcommittee and the Chronic Disease Programs of the Wisconsin Division of Public Health.
 
Current Lifestyle Habits
Never Infrequent Sometimes Often Always
I've been doing moderate or vigorous physical activities for at least 30 minutes in a day, on five or more days a week, and have been doing it for 7 months or longer.
I've been eating 5 or more servings of fruits and vegetables every day, for more than 6 months.
I eat high fat foods less than once/week and have been for more than 6 months.
I've been cooking, eating or purchasing at least 3 servings of whole grain foods every day, for 7 months or longer.
I do not smoke.
I do not feel anxious or nervous.
 
Please rate your interest in any of the following individual physical activity resources.
Very Low Low Neutral High Very High
Attending regular presentations on physical activity topics
Receiving regular physical activity tips via email
Having access to web resources on physical activity
Getting information on existing activities in the area
Point of decision prompts to help you be active (stair/elevator signs)
 
Please rate your interest in any of the following group physical activity resources.
Very Low Low Neutral High Very High
Joining small groups for regular activity (walking groups, yoga class)
Forming clubs for particular physical activities
Discounted memberships at local health clubs, recreation centers, etc.
Participating in a division-wide fitness program initiative with friendly competition between groups
 
Please rate your interest in any of the following nutrition resources.
Very Low Low Neutral High Very High
Attending regular presentations on nutrition topics
Receiving regular healthy eating tips via email
Having access to web resources on nutrition/healthy eating
Getting information on existing food/diet groups in the area
Recipes/healthy meal ideas
Point of decision prompts to help you eat well (i.e. strategically placed healthy eating reminders)
Joining small groups for regular information on diet (ex. Weight Watchers)
 
Please rate your support for any of the following policy or environmental worksite changes.
Very Low Low Neutral High Very High
Review healthy food options for the cafeteria & vending machines; healthy food options labeled
Develop an organization recommendation on food choices for meetings and conferences
Not schedule meetings within the organization on a specific day/time to allow for open time for wellness activities
Provide preventive wellness screenings (blood pressure, body composition, blood cholesterol, diabetes)
Provide Health Risk Appraisals
Provide incentives for participation
Develop policies to support breastfeeding women
 
Please rate your interest in any of the following mental health resources
Very Low Low Neutral High Very High
Attending regular presentations on mental topics
Receiving regular mental health tips via email
Having access to web resources on mental health
Getting information on existing mental health groups in the area
Joining small groups for regular stress reduction classes (relaxation or yoga classes)
 
 
What other things could be done in the worksite to help promote wellness? What would you like to see?