Health Fairs

Employee Health Interest Survey – Please help us learn more about your health interests by taking a few minutes to fill out this survey. Your responses are very important and will be kept confidential. The information will be compiled to help us plan for future wellness activities. We appreciate your input and look forward to a successful wellness program! Please return completed surveys to ______________________________________________.

What is the best way for you to hear about various wellness activities?
___ Flyers/posters
___ Company intranet
___ Bulletin board
___ Paycheck attachment
___ Company newsletter
___ Email

When is the best time for you to participate in wellness activities?
___ Before work
___ After work
___ Lunch hour
___ Would not participate (if checked please indicate why?)
___ Lack of time
___ Lack of motivation
___ Lack of interest

Would you be interested in serving on a wellness committee?
___ Yes         ___ No

Would you be interested in volunteering for a wellness program, health fair?
___ Yes         ___ No

Name:__________________________________________
Phone Number:____________________________________
Email:______________________________________________

Which of the following topics would you be interested in learning more about (check all that apply):
___ Nutrition information/nutrition counseling
___ Weight Watchers at Work program
___ Smoking cessation
___ Gym discounts/memberships
___ Cancer prevention
___ Stress management
___ Ergonomics
___ Heart health
___ Asthma & allergy awareness
___ Diabetes awareness
___ First aid
___ Better sleep
___ Brain health
___ Fitness/exercise
___ Walking program
___ Healthcare consumerism
___ Corporate sports teams. Please check sports of interest:
___ Baseball
___ Basketball
___ Softball
___ Volleyball
___ Other_________________________
___ Screenings. Please check those of interest:
___ Blood pressure
___ Body composition analysis
___ Cholesterol
___ DermaScan
___ Bone density
___ Other_____________________
___ Employee Assistance Program (EAP)
___ Other_______________________________________

Name Our Wellness Program
Here is a chance to use your creativity and brand our wellness program. If we pick your entry you could win ________________
Complete and return this survey by_______________________
We will enter your name into a drawing for a _______________ .
Your Suggestion:
_______________________________________________
_______________________________________________