Healthy People Employer Wellness Survey

Thank you for taking a couple minutes to complete this brief survey. Did you know that we have up to $335 per employee AND spouse in Grant funding to help you have a healthier workforce?

All information will remain confidential and will be used (in aggregate form only) for our grant-funded research and outcomes study on employers' status of wellness and prevention programming in each community nationally.

Once you have completed the survey, a Consultant will contact you to conduct a "Gap Analysis" (addressing the difference between your current initiatives and what is required to be designated as a Healthy Workplace) and review grant-funded programming available to assist your organization in creating a healthier and happier workforce.

More information is available on www.healthypeople2010grant.org.

Questions with * Require an answer.

1. Who or what referred you to this survey?

Who or what referred you to this survey?

*
2. First Name

First Name

*
3. Last Name

Last Name

*
4. Email Address

Email Address

*
5. Verify Email Address

Verify Email Address

*
6. Telephone Number

Telephone Number

*
7. Job Title

Job Title

*
8. Company Name

Company Name

*
9. Company Website

Company Website

*
10. Company Address

Company Address

11. Company Address 2

Company Address 2

*
14. Zip Code

Zip Code

*
15. Number of Employees

Number of Employees

*
16. Number of Locations

Number of Locations

17. Do you meet each criteria below in questions 17 through 21 to be designated as a "Healthy Workplace" as follows ? (Yes/No)

Do you meet each criteria below in questions 17 through 21 to be designated as a "Healthy Workplace" as follows ? (Yes/No)

*
18. Do you identify your employee's behavioral and lifestyle risk factors annually?

Do you identify your employee's behavioral and lifestyle risk factors annually? Yes

19. Do you offer employees access to risk mitigation for all three Wellness Components (physical, mental/emotional and financial/legal) ?

Do you offer employees access to risk mitigation for all three Wellness Components (physical, mental/emotional and financial/legal) ? Yes

20. Do you offer consistent year-round education addressing all three components ?

Do you offer consistent year-round education addressing all three components ? Yes

21. Do you offer adequate incentives to generate a minimum of 75% employee participation

Do you offer adequate incentives to generate a minimum of 75% employee participation Yes

22. Do you include Spouses and Dependents to create a healthier community overall?

Do you include Spouses and Dependents to create a healthier community overall? Yes

23. What are your goals for a Wellness Program ? Please check all that apply.

What are your goals for a Wellness Program ? Please check all that apply. Reduce Insurance Costs

Attract/Retain Employees

Reduce Absenteeism

Increase Productivity

Premium Differential (participate versus non participation)

Premium Differential (Based on health Status)

Have a proactive (versus reactive) benefit plan design

24. Risk Management Programming (Check all that apply below )

	Currently Doing	Plan to Begin
On Site Health Screenings	*Risk Management Programming (Check all that apply below ) On Site Health Screenings Currently Doing	On Site Health Screenings Plan to Begin
Employee Training/Education Programs	Employee Training/Education Programs Currently Doing	Employee Training/Education Programs Plan to Begin
Health Risk Assessments	Health Risk Assessments Currently Doing	Health Risk Assessments Plan to Begin
Health Coaching/Health Management	Health Coaching/Health Management Currently Doing	Health Coaching/Health Management Plan to Begin
Small Group Classes (Smoking,Stress,Weight)	Small Group Classes (Smoking,Stress,Weight) Currently Doing	Small Group Classes (Smoking,Stress,Weight) Plan to Begin
Employee Assistance Program	Employee Assistance Program Currently Doing	Employee Assistance Program Plan to Begin
Disease Management	Disease Management Currently Doing	Disease Management Plan to Begin
Incentive Programs	Incentive Programs Currently Doing	Incentive Programs Plan to Begin
Fitness Center Management	Fitness Center Management Currently Doing	Fitness Center Management Plan to Begin
Gym Discounts	Gym Discounts Currently Doing	Gym Discounts Plan to Begin
Health Fairs/Wellness fairs	Health Fairs/Wellness fairs Currently Doing	Health Fairs/Wellness fairs Plan to Begin
On site Health Promotion Expert	On site Health Promotion Expert Currently Doing	On site Health Promotion Expert Plan to Begin
Health Challenges	Health Challenges Currently Doing	Health Challenges Plan to Begin
Internet Tools and other programs	Internet Tools and other programs Currently Doing	Internet Tools and other programs Plan to Begin
Flu Shots or other Screening Tests	Flu Shots or other Screening Tests Currently Doing	Flu Shots or other Screening Tests Plan to Begin
Fitness Activity Tracking Tools	Fitness Activity Tracking Tools Currently Doing	Fitness Activity Tracking Tools Plan to Begin
Nutrition Activity Tracking Tools	Nutrition Activity Tracking Tools Currently Doing	Nutrition Activity Tracking Tools Plan to Begin
Drug Screening (New Hires)	Drug Screening (New Hires) Currently Doing	Drug Screening (New Hires) Plan to Begin
Random Drug Screening (Current Employees)	Random Drug Screening (Current Employees) Currently Doing	Random Drug Screening (Current Employees) Plan to Begin

25. What is the closest participation percentage for each Risk Management Programming offered? Put 0% if you are not offering that programming.

	0%	< 10%	< 25%	< 40%	< 50%	< 60%	< 75%	> 75%
Health Screening-Employee	*What is the closest participation percentage for each Risk Management Programming offered? Put 0% if you are not offering that programming. Health Screening-Employee 0%	Health Screening-Employee < 10%	Health Screening-Employee < 25%	Health Screening-Employee < 40%	Health Screening-Employee < 50%	Health Screening-Employee < 60%	Health Screening-Employee < 75%	Health Screening-Employee > 75%
Health Screening-Spouse/Dependent	Health Screening-Spouse/Dependent 0%	Health Screening-Spouse/Dependent < 10%	Health Screening-Spouse/Dependent < 25%	Health Screening-Spouse/Dependent < 40%	Health Screening-Spouse/Dependent < 50%	Health Screening-Spouse/Dependent < 60%	Health Screening-Spouse/Dependent < 75%	Health Screening-Spouse/Dependent > 75%
Employee Education- Employee	Employee Education- Employee 0%	Employee Education- Employee < 10%	Employee Education- Employee < 25%	Employee Education- Employee < 40%	Employee Education- Employee < 50%	Employee Education- Employee < 60%	Employee Education- Employee < 75%	Employee Education- Employee > 75%
Employee Education - Spouse/Dependent	Employee Education - Spouse/Dependent 0%	Employee Education - Spouse/Dependent < 10%	Employee Education - Spouse/Dependent < 25%	Employee Education - Spouse/Dependent < 40%	Employee Education - Spouse/Dependent < 50%	Employee Education - Spouse/Dependent < 60%	Employee Education - Spouse/Dependent < 75%	Employee Education - Spouse/Dependent > 75%
Health Risk Assessment- Employee	Health Risk Assessment- Employee 0%	Health Risk Assessment- Employee < 10%	Health Risk Assessment- Employee < 25%	Health Risk Assessment- Employee < 40%	Health Risk Assessment- Employee < 50%	Health Risk Assessment- Employee < 60%	Health Risk Assessment- Employee < 75%	Health Risk Assessment- Employee > 75%
Health Risk Assessment - Spouse/Dependent	Health Risk Assessment - Spouse/Dependent 0%	Health Risk Assessment - Spouse/Dependent < 10%	Health Risk Assessment - Spouse/Dependent < 25%	Health Risk Assessment - Spouse/Dependent < 40%	Health Risk Assessment - Spouse/Dependent < 50%	Health Risk Assessment - Spouse/Dependent < 60%	Health Risk Assessment - Spouse/Dependent < 75%	Health Risk Assessment - Spouse/Dependent > 75%
Health Risk Review - Employee	Health Risk Review - Employee 0%	Health Risk Review - Employee < 10%	Health Risk Review - Employee < 25%	Health Risk Review - Employee < 40%	Health Risk Review - Employee < 50%	Health Risk Review - Employee < 60%	Health Risk Review - Employee < 75%	Health Risk Review - Employee > 75%
Health Risk Review - Spouse/Dependent	Health Risk Review - Spouse/Dependent 0%	Health Risk Review - Spouse/Dependent < 10%	Health Risk Review - Spouse/Dependent < 25%	Health Risk Review - Spouse/Dependent < 40%	Health Risk Review - Spouse/Dependent < 50%	Health Risk Review - Spouse/Dependent < 60%	Health Risk Review - Spouse/Dependent < 75%	Health Risk Review - Spouse/Dependent > 75%
Health Coaching- Employee	Health Coaching- Employee 0%	Health Coaching- Employee < 10%	Health Coaching- Employee < 25%	Health Coaching- Employee < 40%	Health Coaching- Employee < 50%	Health Coaching- Employee < 60%	Health Coaching- Employee < 75%	Health Coaching- Employee > 75%
Health Coaching- Spouse/Dependent	Health Coaching- Spouse/Dependent 0%	Health Coaching- Spouse/Dependent < 10%	Health Coaching- Spouse/Dependent < 25%	Health Coaching- Spouse/Dependent < 40%	Health Coaching- Spouse/Dependent < 50%	Health Coaching- Spouse/Dependent < 60%	Health Coaching- Spouse/Dependent < 75%	Health Coaching- Spouse/Dependent > 75%
Small Group Classes- Employee	Small Group Classes- Employee 0%	Small Group Classes- Employee < 10%	Small Group Classes- Employee < 25%	Small Group Classes- Employee < 40%	Small Group Classes- Employee < 50%	Small Group Classes- Employee < 60%	Small Group Classes- Employee < 75%	Small Group Classes- Employee > 75%
Small Group Classes -Spouse/Dependents	Small Group Classes -Spouse/Dependents 0%	Small Group Classes -Spouse/Dependents < 10%	Small Group Classes -Spouse/Dependents < 25%	Small Group Classes -Spouse/Dependents < 40%	Small Group Classes -Spouse/Dependents < 50%	Small Group Classes -Spouse/Dependents < 60%	Small Group Classes -Spouse/Dependents < 75%	Small Group Classes -Spouse/Dependents > 75%
Employee Assistance Program - Employee	Employee Assistance Program - Employee 0%	Employee Assistance Program - Employee < 10%	Employee Assistance Program - Employee < 25%	Employee Assistance Program - Employee < 40%	Employee Assistance Program - Employee < 50%	Employee Assistance Program - Employee < 60%	Employee Assistance Program - Employee < 75%	Employee Assistance Program - Employee > 75%
Employee Assistance Program -Spouse/Dependent	Employee Assistance Program -Spouse/Dependent 0%	Employee Assistance Program -Spouse/Dependent < 10%	Employee Assistance Program -Spouse/Dependent < 25%	Employee Assistance Program -Spouse/Dependent < 40%	Employee Assistance Program -Spouse/Dependent < 50%	Employee Assistance Program -Spouse/Dependent < 60%	Employee Assistance Program -Spouse/Dependent < 75%	Employee Assistance Program -Spouse/Dependent > 75%
Gym Discounts -Employee	Gym Discounts -Employee 0%	Gym Discounts -Employee < 10%	Gym Discounts -Employee < 25%	Gym Discounts -Employee < 40%	Gym Discounts -Employee < 50%	Gym Discounts -Employee < 60%	Gym Discounts -Employee < 75%	Gym Discounts -Employee > 75%
Gym Discounts - Spouse/Dependent	Gym Discounts - Spouse/Dependent 0%	Gym Discounts - Spouse/Dependent < 10%	Gym Discounts - Spouse/Dependent < 25%	Gym Discounts - Spouse/Dependent < 40%	Gym Discounts - Spouse/Dependent < 50%	Gym Discounts - Spouse/Dependent < 60%	Gym Discounts - Spouse/Dependent < 75%	Gym Discounts - Spouse/Dependent > 75%
Health Fairs- Employee	Health Fairs- Employee 0%	Health Fairs- Employee < 10%	Health Fairs- Employee < 25%	Health Fairs- Employee < 40%	Health Fairs- Employee < 50%	Health Fairs- Employee < 60%	Health Fairs- Employee < 75%	Health Fairs- Employee > 75%
Health Fairs - Spouse/Dependent	Health Fairs - Spouse/Dependent 0%	Health Fairs - Spouse/Dependent < 10%	Health Fairs - Spouse/Dependent < 25%	Health Fairs - Spouse/Dependent < 40%	Health Fairs - Spouse/Dependent < 50%	Health Fairs - Spouse/Dependent < 60%	Health Fairs - Spouse/Dependent < 75%	Health Fairs - Spouse/Dependent > 75%
Internet Tools- Employee	Internet Tools- Employee 0%	Internet Tools- Employee < 10%	Internet Tools- Employee < 25%	Internet Tools- Employee < 40%	Internet Tools- Employee < 50%	Internet Tools- Employee < 60%	Internet Tools- Employee < 75%	Internet Tools- Employee > 75%
Internet Tools -Spouse/Dependent	Internet Tools -Spouse/Dependent 0%	Internet Tools -Spouse/Dependent < 10%	Internet Tools -Spouse/Dependent < 25%	Internet Tools -Spouse/Dependent < 40%	Internet Tools -Spouse/Dependent < 50%	Internet Tools -Spouse/Dependent < 60%	Internet Tools -Spouse/Dependent < 75%	Internet Tools -Spouse/Dependent > 75%

Other (please specify)

26. When do you plan on implementing/expanding your Wellness Program?

When do you plan on implementing/expanding your Wellness Program? 1 - 3 Months

3 - 6 Months

6 - 12 Months

No firm date set

27. When is your benefit renewal date?

When is your benefit renewal date?

28. What is your company's estimated monthly budget per employee per month PEPM for Wellness Programs?

What is your company's estimated monthly budget per employee per month PEPM for Wellness Programs?

Healthy People Employer Wellness Survey
Exit this survey

1. Default Section

1. Who or what referred you to this survey?

*
2. First Name

*
3. Last Name

*
4. Email Address

*
5. Verify Email Address

*
6. Telephone Number

*
7. Job Title

*
8. Company Name

*
9. Company Website

*
10. Company Address

11. Company Address 2

*
12. City

*
13. State

*
14. Zip Code

*
15. Number of Employees

*
16. Number of Locations

17. Do you meet each criteria below in questions 17 through 21 to be designated as a "Healthy Workplace" as follows ? (Yes/No)

*
18. Do you identify your employee's behavioral and lifestyle risk factors annually?

19. Do you offer employees access to risk mitigation for all three Wellness Components (physical, mental/emotional and financial/legal) ?

20. Do you offer consistent year-round education addressing all three components ?

21. Do you offer adequate incentives to generate a minimum of 75% employee participation

22. Do you include Spouses and Dependents to create a healthier community overall?

23. What are your goals for a Wellness Program ? Please check all that apply.

24. Risk Management Programming (Check all that apply below )

25. What is the closest participation percentage for each Risk Management Programming offered? Put 0% if you are not offering that programming.

26. When do you plan on implementing/expanding your Wellness Program?

27. When is your benefit renewal date?

28. What is your company's estimated monthly budget per employee per month PEPM for Wellness Programs?

Healthy People Employer Wellness SurveyExit this survey

1. Default Section

1. Who or what referred you to this survey?

*2. First Name

*3. Last Name

*4. Email Address

*5. Verify Email Address

*6. Telephone Number

*7. Job Title

*8. Company Name

*9. Company Website

*10. Company Address

11. Company Address 2

*12. City

*13. State

*14. Zip Code

*15. Number of Employees

*16. Number of Locations

17. Do you meet each criteria below in questions 17 through 21 to be designated as a "Healthy Workplace" as follows ? (Yes/No)

*18. Do you identify your employee's behavioral and lifestyle risk factors annually?

19. Do you offer employees access to risk mitigation for all three Wellness Components (physical, mental/emotional and financial/legal) ?

20. Do you offer consistent year-round education addressing all three components ?

21. Do you offer adequate incentives to generate a minimum of 75% employee participation

22. Do you include Spouses and Dependents to create a healthier community overall?

23. What are your goals for a Wellness Program ? Please check all that apply.

24. Risk Management Programming (Check all that apply below )

25. What is the closest participation percentage for each Risk Management Programming offered? Put 0% if you are not offering that programming.

26. When do you plan on implementing/expanding your Wellness Program?

27. When is your benefit renewal date?

28. What is your company's estimated monthly budget per employee per month PEPM for Wellness Programs?

Healthy People Employer Wellness Survey
Exit this survey

*
2. First Name

*
3. Last Name

*
4. Email Address

*
5. Verify Email Address

*
6. Telephone Number

*
7. Job Title

*
8. Company Name

*
9. Company Website

*
10. Company Address

*
12. City

*
13. State

*
14. Zip Code

*
15. Number of Employees

*
16. Number of Locations

*
18. Do you identify your employee's behavioral and lifestyle risk factors annually?