Employee Wellness Challenge Registration Form

Please answer all these questions.  Do not overthink your answers; answer with your first intuitive response.

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Which age range do you fall in?

Question Title

* 4. Email Address

Question Title

* 5. Department Name

Question Title

* 6. Why are you participating in the Employee Wellness?

Question Title

* 7. How satisfied are you with your overall health and wellness?

Question Title

* 8. What is a motivator for you to maintain your health?

Question Title

* 9. What aspect of the lifestyle health wheel are you MOST confident?

Question Title

* 10. What aspect of the lifestyle health wheel are you LEAST confident about?

Question Title

* 11. How satisfied are you with your fitness level?

Question Title

* 12. How many minutes per week do you participate in moderate-intensity exercise?

Question Title

* 13. How satisfied are you with your current fitness choices?

Question Title

* 14. Please provide examples of your preferred type of physical activity. (ex: weight lifting, walking, stretching, dancing...)

Question Title

* 15. How confident are you that you could incorporate more physical activity into your day?

Question Title

* 16. How satisfied are you with your current nutritional choices?

Question Title

* 17. How many servings of fruits and vegetables do you eat per day?

Question Title

* 18. How confident are you with knowing what your personal nutrition needs are?

Question Title

* 19. How satisfied are you with your quality of sleep?

Question Title

* 20. Do you make sleep a priority?

Question Title

* 21. Do you have a sleep routine?

Question Title

* 22. Please state which of the following activities do you usually do just before you go off to sleep?

Question Title

* 23. How satisfied are you with your current level of stress?

Question Title

* 24. Please provide insight on your current level of stress.

Question Title

* 25. How satisfied are you with how you cope with stress?

Question Title

* 26. Have you experienced a significant stressor whether medical or otherwise life changing in the past 12 months?

Question Title

* 27. How confident do you feel with your skills to cope with your stress?

Question Title

* 28. Where does most of your stress come from?

Question Title

* 29. How satisfied have you felt with yourself over the past 6 months?

Question Title

* 30. How confident have you been feeling in your capabilities recently?

Question Title

* 31. How frequently have you engaged in activities that you find interesting and/or bring you healthful pleasure?

Question Title

* 32. Would you like more information on employee support such as R.E.S.T., Spiritual Services, and/or the E.A.P.?

Page1 / 1
 
 100% of survey complete.

T