Wellness
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1. General Wellness Information

It is important to enter your department and age range to determine feasibility of certain initiatives. Age
Department
Gender
Full-Time Employee
Part-Time Employee

Have you ever been active in the Rockingham County Wellness Program? Yes

Do you know about the Wellness Initiative in which Wellness Points may be used to earn accrual time? Yes

Do you currently participate in the Wellness Points program? Yes

Do you plan to participate in the future? Yes

Don't Know

Do you participate in physical activity: Less than twice weekly

2-4 times weekly

More than four times weekly

Do you consider your diet choices: reasonably healthy

somewhat healthy

not very healthy

Are you intersted in having healthy snacks available for purchase at work? Yes

	Little or No Interest	Somewhat Interested	Very Interested
Basketball	*In which TEAM activities are you interested in participating if the County arganized the activity? Basketball Little or No Interest	Basketball Somewhat Interested	Basketball Very Interested
Bowling	Bowling Little or No Interest	Bowling Somewhat Interested	Bowling Very Interested
Frisby Football	Frisby Football Little or No Interest	Frisby Football Somewhat Interested	Frisby Football Very Interested
Golf Scramble	Golf Scramble Little or No Interest	Golf Scramble Somewhat Interested	Golf Scramble Very Interested
Soccer	Soccer Little or No Interest	Soccer Somewhat Interested	Soccer Very Interested
Softball	Softball Little or No Interest	Softball Somewhat Interested	Softball Very Interested
Volleyball	Volleyball Little or No Interest	Volleyball Somewhat Interested	Volleyball Very Interested

Other (please specify)

	Little or No Interest	Somewhat Interested	Very Interested
Aerobics	*In which INDIVIDUAL activities are you interested in participating if the County organized the activity? Aerobics Little or No Interest	Aerobics Somewhat Interested	Aerobics Very Interested
Bicycling Outdoors	Bicycling Outdoors Little or No Interest	Bicycling Outdoors Somewhat Interested	Bicycling Outdoors Very Interested
Circuit Training	Circuit Training Little or No Interest	Circuit Training Somewhat Interested	Circuit Training Very Interested
Jogging	Jogging Little or No Interest	Jogging Somewhat Interested	Jogging Very Interested
Palates	Palates Little or No Interest	Palates Somewhat Interested	Palates Very Interested
Step Aerobics	Step Aerobics Little or No Interest	Step Aerobics Somewhat Interested	Step Aerobics Very Interested
Tai Chi	Tai Chi Little or No Interest	Tai Chi Somewhat Interested	Tai Chi Very Interested
Turbo Jam	Turbo Jam Little or No Interest	Turbo Jam Somewhat Interested	Turbo Jam Very Interested
Walking	Walking Little or No Interest	Walking Somewhat Interested	Walking Very Interested
Water Aerobics	Water Aerobics Little or No Interest	Water Aerobics Somewhat Interested	Water Aerobics Very Interested
Yoga	Yoga Little or No Interest	Yoga Somewhat Interested	Yoga Very Interested
Zumba	Zumba Little or No Interest	Zumba Somewhat Interested	Zumba Very Interested

Other (please specify)

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