HCHD Employee Wellness Health Risk Assessment

Please complete this health risk assessment. Results will be used to assist HCHD Employee Wellness in compiling vital health information to better serve its employees. Please answer all questions. Thank you for your support!

1. Is Aetna your provider for health insurace?

Is Aetna your provider for health insurace? Yes

2. Are you a retiree of the Harris County Hospital District?

Are you a retiree of the Harris County Hospital District? Yes

3. What is your weekly Physical Activity?

What is your weekly Physical Activity? a. More than 30 minutes of moderate to strenuous physical activity 7 days per week

b. At least a total of 30 minutes of moderate physical activity 5 or more days per week

c. Infrequent or no regular physical activity

4. What is your current Body Mass Index (BMI)? To calculate your BMI, go to the following website: CDC's BMI Calculator

What is your current Body Mass Index (BMI)? To calculate your BMI, go to the following website: CDC's BMI Calculator a. BMI less than 25 - Healthy body weight

b. BMI between 25 and 29.9 - Overweight

c. BMI greater than 30 - Obese

5. What is your Systolic Blood Pressure (top number)?

What is your Systolic Blood Pressure (top number)? a. Below 130 mm Hg - Normal

b. Between 130 and 139 mm Hg - High (Pre-Hypertension)

c. 140 mm Hg or higher - Very High (Hypertension)

Comments:

6. What is your Diastolic Blood Pressure (bottom number)?

What is your Diastolic Blood Pressure (bottom number)? a. Below 80 mm Hg - Normal

b. Between 80 and 89 mm Hg - High (Pre-Hypertension)

c. 90 mm Hg or higher - Very High (Hypertension)

Comments:

7. What was your last Total Cholesterol reading?

What was your last Total Cholesterol reading? a. Total reading of less than 200 mg/dl - Normal

b. Total reading of 200 mg/dl to 239 mg/dl - High

c. Total reading of 240 mg/dl or higher - Very High

Comments

8. What was you last Fasting Blood Sugar reading?

What was you last Fasting Blood Sugar reading? a. Below 110 mg/dl - Normal

b. Between 110 mg/dl and 125 mg/dl - High

c. 126 mg/dl or higher - Very High

Comments

9. What does your Daily Diet consist of?

What does your Daily Diet consist of? a. Whole grains, low-fat dairy, lean meats, and 4 to 5 servings of fruits and vegetables per day

b. Whole grains, low-fat dairy, lean meats most of the time, and 2 to 3 servings of fruits and vegetables per day

c. Most servings per day consists of high-fat meats and dairy products, and very few whole grains, fruits and vegetables

10. What are your Smoking Habits?

What are your Smoking Habits? a. Never smoked or haven't smoked in the past 15 years

b. Quit smoking between 10 and 15 years ago

c. Current smoker or stopped smoking less than 10 years ago

11. What are your habits on Alcohol Consumption?

What are your habits on Alcohol Consumption? a. Non-drinker or drink fewer than 2 drinks per day for men, and less than 1 drink per day for women

b. Drink no more than 2 drinks per day for men, and 1 drink per day for women

c. Drink more than 2 drinks per day for men, and more than 1 drink per day for women

12. What has been your level of Stress over the past 12 months?

What has been your level of Stress over the past 12 months? a. No significant life changes over the past 12 months. Usually feel in control during stressful periods

b. Moderate life changes over the past 12 months. Generally feel in control during stressful periods

c. Major changes over the past 12 months. Feel you have little control during stressful periods

13. What are your habits on using Seat Belts?

What are your habits on using Seat Belts? a. Always use seat belt

b. Use seatbelt most of the time

c. Never use or sometimes use seat belt

What Is Your Overall Health Risk?

Please review your answers on questions 3 thru 13, and check to see how you scored:

• If you answered mostly a: Your overall health risk is lower than the average adult.
• If you answered mostly b: Your health risk profile is moderate. May indicate borderline risks.
• If you answered mostly c: You are at high risk for associated health problems.

This health-risk awareness tool is not intended to diagnose medical problems nor does it replace provessional medical consultation.

Source: HealthView Personal Health Risk Assessment, The WorkCare Group, Inc.

1. Health Risk Assessment - Questions

1. Is Aetna your provider for health insurace?

2. Are you a retiree of the Harris County Hospital District?

3. What is your weekly Physical Activity?

4. What is your current Body Mass Index (BMI)? To calculate your BMI, go to the following website: CDC's BMI Calculator