Staff Member Wellness Program Interest Survey.

We’re planning company wellness programs to help you feel better and stay healthful. In order to plan wellness programs that best meet your needs and interests we would like your suggestions!

Please take several 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 wellness programs for you. Do not 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 â.” 3 with one (1) being of little or no interest; two (2) being of some interest and three (3) indicating that you are 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 health promotion programs after work 1 2 3

Participating in health promotion programs during my lunch break 1 2 3

Learning healthy eating choices to lose weight 1 2 3

Sports nutrition 1 2 3

Healthier cooking 1 2 3

Helping my children eat healthier 1 2 3

Quick, healthful meals for busy life choices 1 2 3

Healthful snack choices 1 2 3

Learning how to quit smoking 1 2 3

Attending classes to help me quit tobacco use 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

Creating time to exercise for busy people  1 2 3

Getting health information that I can peruse or watch at home 1 2 3

Learning about cancer prevention 1 2 3

Heart health choices 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 raise intake of fruits and vegetables 1 2 3

Parenting Topics (age of children –  ) 1 2 3

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

Medical testing like blood pressure, cholesterol, blood sugar 1 2 3