Wellness Plans : Staff Member Wellness Program Interest Survey.

We are planning corporation health promotion programs to help you feel better and stay healthy. In order to plan health promotion programs that best meet your needs and interests we’d like your suggestions!

Please take a few minutes to answer some questions about your interests. Your answers are going to be combined with those of other’s and reviewed to help plan health promotion programs for you. Don’t 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 health promotion 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’re 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 health promotion programs during my lunch break 1 2 3

Learning healthy consuming 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, healthy meals for busy life choices 1 2 3

Healthful snack options 1 2 3

Learning how to quit tobacco use 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 beginning fitness program 1 2 3

Developing time to exercise for busy people  1 2 3

Getting medical information that I can read or watch at home 1 2 3

Learning about cancer avoidance 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 increase intake of fruits and vegetables 1 2 3

Parenting Topics (age of kids –  ) 1 2 3

On-Site exercise classes –  walking Yoga aerobic other –  1 2 3

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