1. Overall, how have participation rates in your wellness program changedover the past two years?
Remained about the same
Doesn’t apply, we are just getting started
2. What department is your wellness program located in?
- Human Resources
- Medical/Occupational Health
- Health Promotion
- Other (please explain)
3. How many employees does your organization have?
- Under 50
4. What type of industry best classifies your organization?
- Other (please list)
5. What is the approximate annual budget of your current wellness initiative?
6. Which statement(s) best describes the reason why your organization starteda wellness initiative? (Check all that apply)
To improve teamwork/morale
To enhance productivity
To meet our employees’ requests
To improve the health and well-being of our employees
To contain costs
To improve recruitment/retention
To reduce absenteeism
Other (please explain)
7. Support for our organization’s wellness initiative is demonstrated bythe fact that: (please answer yes or no)
Our CEO genuinely believes in the value of worksite wellness.
A statement concerning employee health and well-being has beenincorporated into the company’s vision/mission statement.
Our CEO has communicated the importance of wellness to all employees (e.g.formal written memo, incorporated into orientation, public addresses, etc.).
The company has formally appointed an individual(s) and/or a committee tolead the wellness initiative.
Senior level management allocates the necessary resources for the wellnessprogram (e.g. budget, materials, people, space, etc.).
Our CEO and senior level executives regularly take part in the activitiesoffered.
Middle level management supports the wellness program
Middle level management regularly participates in wellness activities
8. Integration of the health promotion program is demonstrated by the fact that: (pleaseanswer yes or no )
A representative wellness committee involving the organizations’ keyemployees/constituents has been established (e.g. human resource/benefits,occupational health, MIS, etc.).
The wellness committee has developed a compelling vision, establishedstrategic priorities, and defined individual roles and responsibilities.
The wellness committee has a strong and effective leader.
The wellness committee functions cohesively and effectively.
The wellness committee meets regularly throughout the year.
The proceedings of the meetings are consistently communicated to seniorlevel executives.
9. In order to make strategic decisions, the following sources of data have been collected and analyzed within the last: (please check theappropriate response)
Number of months
Have not collected
|Health risk appraisal||12||24||36||48|
|Health Screening (e.g. height, weight, blood profile, etc.)|
|Employee health interest surveys|
|Health needs/interests of dependents and/or retirees|
|Physical fitness assessments|
|Work/family needs assessment|
|Ergonomic/work station analysis|
|Demographic information of employees/dependents|
|Health care claims and utilization|
|Worker compensation claims|
|Corporate culture audit|
10. In order to provide clarity and focus to our wellness initiative, we have: (please check the appropriate response)
Carefully developed an operating plan that addresses our employee’shealth needs and interests.
Established clear, concise, and measurable goals and objectives that arelinked to and supported by data.
Linked our wellness goals and objectives to the organizations’ strategicpriorities and outcomes.
Incorporated specific timelines within the operating plan indicating whenactivities/tasks are to be completed.
Assigned specific responsibilities to an individual or group for thecompletion of important tasks.
Allocated an itemized budget sufficient to carry out the plan.
Incorporated appropriate marketing strategies to effectively promote andcommunicate our programs to the employees and their dependents.
A plan has been developed to evaluate the stated goals and objectives
11. To address the health needs and interests of our employees and theirdependents, our organization has offered the following programs in the last 24months:
|Programs Offered:||Health Information||Group Education||Self Study||Computer Based/Inter/Intranet||Personal Counseling/At Risk||Ongoing Behavior Change|
|Nutrition/ weight management|
|Responsible alcohol use|
|Work & Family|
|Personal financial management|
12. Are any of the above programs: offered to employees' families? (pleaseanswer yes or no)
13. Does the organization regularly participate in community healthpromotion or social service activities? (i.e blood drives,run/walk-a-thon, clothing/food drives). (please answer yes or no)
14. Our organization is committed to evaluating our wellness program in thefollowing ways: (please answer yes or no)
Regularly tracking participation.
Monitoring participant satisfaction.
Documenting improvements in knowledge, attitudes, skills, and behaviors.
Assessing changes in biometric measures (e.g., body weight, strength,flexibility, cholesterol levels, blood pressure, etc.).
Assessing and monitoring the health status of "at-risk" employees.
Measuring changes in both the physical and cultural environment (e.g.,policies, benefits, working conditions, etc.).
Monitoring the impact of wellness on key productivity indicators (e.g.,absenteeism, turnover, morale, etc.).
Analyzing cost effectiveness, cost savings, and return on investment.
15. To keep all members of the organization informed, we regularly andcontinuously: (please answer yes or no )
Provide program updates to senior level executives.
Circulate information concerning the availability of community resources(e.g., child care, elder care, parks, etc.).
Communicate changes in policy and benefit options.
Distribute reminders to employees and their families concerning upcomingactivities and events.
Encourage ongoing dialogue by providing opportunities for employee input.
Provide timely feedback to individuals that are involved in the company’sprograms .
Allow employees to communicate feedback through formal communicationchannels (e.g. suggestion boxes, e-mail, surveys, etc.).
Communicate program results to all levels of management .
16. In order to provide a supportive organizational environment, we:(please answer yes or no)
Provide our employees with release time so that they can participate inour health promotion activities.
Practice disability prevention and management (e.g. early return to work,restricted duty, etc
Reimburse our employees for health club memberships and/or other wellness program
Provide incentives to our employees to increase participation in ourwellness initiatives
Offer our employees peer support groups and mentoring opportunities
Make healthy food options available in our vending machines and cafeteria
Ensure that all workstations are ergonomically sound.
Monitor our facility’s heating, lighting, ventilation, and overallsafety.
Maintain an easily accessible wellness library.
Offer assistance to help employees address issues of work/life balance
Recognize and reward successes.
Provide the following benefit options: (check all that apply)
- Health insurance
- Life insurance
- Sick leave/well days off
- Leave of absence
- Compensatory time off
- Flex time
- Job sharing
- Work at home/telecommuting
- Maternal/paternal leave
- Family leave
- Child care
- Dependent care flexible spending accounts
- Health promotion program prepayment or reimbursement
- Retirement/investment plan
- Tuition reimbursement
- Job training or reimbursement
- Others (Please list)
17. In order to provide a supportive organizational environment, we providethe following policies (check all that apply):
- Smoke free workplace
- Tobacco restrictions
- Seatbelt/safe driving practices
- Healthy food options
- Emergency procedures
- Other (Please list)
Reprinted with permission from the Wellness Council ofAmerica, a worksitewellness membership organization with over 3,000 members.
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