Worksite Wellness Survey

1. Name of person completing this survey

2. Title of person completing this survey

3. Contact email address

4. Name of Company

5. How many people work at your company? (including sites outside Taylor County) (individuals, not FTE's) (use ranges from question #6)

6. How many people work at your company's site in Taylor County?

7. Indicate your business classification / type of worksite

Transportation / Communication / Utilities
Wholesale
Manufacturing
Health Care
Services
Government
Education
Agriculture / Mining / Construction / Forestry
Finance
Other (Please Specify)

8. Does your company offer worksite wellness activities? (If yes, please move ahead to question #13. If no, please continue with question #9.)

Yes No

9. Why doesn't your company have a wellness program? (Check the top 3 most important reasons)

Lack of management support

Lack of need or benefit

Lack of funding / Costs too much

Lack of staff / Don't have staff or time to run the program

Don't know how or where to start

Lack of employee motivation / interest

Other (Please Specify)

10. In regards to development of an employee wellness program, what stage is your company at?

Not considering an employee wellness program at this time
Thinking about starting an employee wellness program within the next 6 months
Currently developing an employee wellness program

11. Which of the following would be the greatest influence in your company's decision to establish a company wellness program for your employees? (Check one.)

Improved morale
Less absenteeism
Increased productivity
Improved health
Reduced health care costs
Other

12. If you were to implement an employee wellness program, rank your interest in each of the following services that you might address: (When you are finished with letters a - l in this section, pleaes skip to question #24.)

a. Fitness/Physical Activities On Site:
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

b. Fitness/Physical Activities Off-Site (ex. Health Club Subsidy):
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

c. Nutritional Information and/or Counseling:
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

d. Weight Management:
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

e. Smoking Cessation:
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

f. Health screenings (Blood Pressure, Cholesterol, Diabetes):
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

g. Health Risk Assessments:
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

h. Stress Management:
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

i. Prenatal Care/Reproductive Health:
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

j. Disease Management (Diabetes, Cardiovascular, etc.):
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

k. Health Education Classes:
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

l. Injury Prevention / Safety Education:
Not at all interested.
A littled interested.
Somewhat interested.
Very interested.
Extremely interested.

13. Which of the following had the greatest influence on your company's decision to establish a wellness program for your employees? (Check the top 3)

Improved morale

Less absenteeism

Increased productivity

Improved health

Reduced health care costs

Management commitment

Other (Please Specify)

14. As a result of your wellness program, what has happened to your company's health care costs?

Decreased
Stayed the same
Increased
Too early to tell
We don't measure effects on health care costs
Other (Please Specify)

15. How is your company's wellness program funded? (Check all that apply)

Company cover costs

Part of health insurance coverage

User fees

No specific funding

Other (Please Specify)

16. In the past year, what percentage of your job responsibilities (or the primary person in charge of the wellness program) were devoted to management of your company's wellness program?

None. Employee wellness is an additional task as part of a broader job.
1% - 25%
26% - 50%
51% - 75%
75% - 99%
100%

17. How many full-time equivalent employees currently work on your company wellness program? Note: this number should be calculated by adding up all the percentages of staff job responsibilities dedicated to company wellness programs.

None.
less than 1
1 - 2
3 - 5
5 or more

18. What is the main job responsibility/title for the lead person involved in the employee wellness program?

Wellness coordinator
Human resources staff
Nurse
Occupational Health / Safety
General staff with wellness assigned as an additional duty
Other (Please Specify)

19. In the past year, what percentage of your employees participated in at least one component of your wellness program? (Use your own internal measure of what constitutes participation. A component would be any longer term initiative such as a series of classes or several week fitness campaign.)

Less than 10%.
10% - 25%
26% - 50%
51% - 75%
76% - 100%
We don't measure participation rates.

20. Our company program provides the following services: (rank the frequency of program services)

a. Fitness/Physical Activity On-Site:
Never
Rarely
Sometimes
Often
Always

b. Fitness/Physical Activity Programs Off-Site (ex. Health Club Subsidy):
Never
Rarely
Sometimes
Often
Always

c. Nutritional information and/or ccounseling
Never
Rarely
Sometimes
Often
Always

d. Weight management
Never
Rarely
Sometimes
Often
Always

e. Smoking cessation
Never
Rarely
Sometimes
Often
Always

f. Health screenings (Blood pressure, cholesterol, diabetes)
Never
Rarely
Sometimes
Often
Always

g. Health risk assessments (HRA)
Never
Rarely
Sometimes
Often
Always

h. Stress management
Never
Rarely
Sometimes
Often
Always

i. Prenatal care/Reproductive Health
Never
Rarely
Sometimes
Often
Always

j. Disease management (diabetes, cardiovascular, etc.)
Never
Rarely
Sometimes
Often
Always

k. Health education classes
Never
Rarely
Sometimes
Often
Always

l. Injury prevention/ Safety Education
Never
Rarely
Sometimes
Often
Always

21. How do you communicate information about your wellness program to employees? (Check all that apply)

Internet (internal or external web site)

Newsletters

Payroll Stuffers

Bulletin Boards

Other (Please Specify)

22. Our facility provides the following on-site resources: (Check all that apply)

Exercise facility / room

Locker rooms / showers

Bike racks

Walking paths

Cafeteria with healthy choices

Vending machines with healthy choices

Refrigerators, freezer and equipment to heat food (microwave, etc.)

Breastfeeding room

Other (Please Specify)

23. Our company has the following wellness policies in place: (Check all that apply)

Creation or support of an employee wellness committee.

Support of physical activity during work time (flex time).

Management encouragement of employees to be active during break time.

Reduced fees or subsidized use of fitness facilities.

Provision of an employee incentive system such as positive publicity, equipment or money.

Emphasis on improving the built environment through trails, maps, bike racks, etc.

Office standard that encourages healthy food and beverage choices in the work environment.

Provision of healthy food and beverage choices at worksite cafeterias.

Provision of healthy food options for any worksite meetings, conferences or trainings.

Provision of vending machines offering healthy food and beverage choices.

24. Would a worksite health promotion resource kit be beneficial to you and your employees?

Yes No I don't know

25. What tools or resources would be helpful to you? (Rate the relative usefulness to you of the elements listed bleow.)

a. A summary of how-to-get started:
Not at all helpful
A little helpful
Somewhat helpful
Very helpful
Extremely helpful

b. A simple/brief summary of possible wellness program components:
Not at all helpful
A little helpful
Somewhat helpful
Very helpful
Extremely helpful

c. Sample letters (i.e. program announcements):
Not at all helpful
A little helpful
Somewhat helpful
Very helpful
Extremely helpful

d. Sample educational materials:
Not at all helpful
A little helpful
Somewhat helpful
Very helpful
Extremely helpful

e. Sample policies:
Not at all helpful
A little helpful
Somewhat helpful
Very helpful
Extremely helpful

f. A person to talk to for ideas and advice:
Not at all helpful
A little helpful
Somewhat helpful
Very helpful
Extremely helpful

g. How to evaluate a wellness program (health effects and return on investment):
Not at all helpful
A little helpful
Somewhat helpful
Very helpful
Extremely helpful

26. If resources were available, in what format would they be helpful to you: (Check all that apply)

Internet, with downloads available

Paper copy, in a binder

CD-ROM

Other (Please Specify)

27. Is there any other information you would like us to know?