We are planning company health promotion programs to help you feel better and stay healthful. So that you can plan health promotion programs that best meet your requirements and interests we’d 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. Don’t 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 wellness programs. Return the completed form by _____________.
Rate your interest on a scale of 1 – 3 with one (1) being of little or no interest; two (2) being of some interest and three (3) indicating that you’re very interested. Indicate your response by circling or “Xing” the number.
I’m interested in
Participating in health promotion programs before work 1 2 3
Participating in wellness programs after work 1 2 3
Participating in health promotion programs during my lunch break 1 2 3
Learning healthful consuming options to lose weight 1 2 3
Sports nutrition 1 2 3
Healthier cooking 1 2 3
Assisting my children eat healthier 1 2 3
Quick, healthful meals for busy life choices 1 2 3
Healthy snack options 1 2 3
Learning how to quit use of tobacco 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 starting fitness program 1 2 3
Developing time to exercise for busy people 1 2 3
Getting medical information that I can read or watch at home 1 2 3
Learning about cancer avoidance 1 2 3
Heart health options 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
Biometric screening like blood pressure, cholesterol, blood sugar 1 2 3
