SurveyMonkey Powered Online Survey

Optional Employee Wellness Program Survey

Thank you for agreeing to complete the following survey about additional programs you might be offering your employees. The information you provide will help us learn more about employee wellness programs so that we can better support Sonoma County businesses in developing employee wellness programs.

Again, the survey is optional. Your answers will not be scored.

1. Please provide the following information for your business or organization:

Please provide the following information for your business or organization: Employer
City:

2. Health Promotion

	Yes	No	Unknown	NA
a) Does your worksite offer healthy eating and/or nutrition classes?	*Health Promotion a) Does your worksite offer healthy eating and/or nutrition classes? Yes	a) Does your worksite offer healthy eating and/or nutrition classes? No	a) Does your worksite offer healthy eating and/or nutrition classes? Unknown	a) Does your worksite offer healthy eating and/or nutrition classes? NA
b) Does your worksite offer employees nutrition or diet management counseling?	b) Does your worksite offer employees nutrition or diet management counseling? Yes	b) Does your worksite offer employees nutrition or diet management counseling? No	b) Does your worksite offer employees nutrition or diet management counseling? Unknown	b) Does your worksite offer employees nutrition or diet management counseling? NA
c) Does your worksite offer an annual fitness assessment to employees?	c) Does your worksite offer an annual fitness assessment to employees? Yes	c) Does your worksite offer an annual fitness assessment to employees? No	c) Does your worksite offer an annual fitness assessment to employees? Unknown	c) Does your worksite offer an annual fitness assessment to employees? NA
d) Does your worksite offer health risk assessments to employees?	d) Does your worksite offer health risk assessments to employees? Yes	d) Does your worksite offer health risk assessments to employees? No	d) Does your worksite offer health risk assessments to employees? Unknown	d) Does your worksite offer health risk assessments to employees? NA
e) Does your worksite offer tobacco cessation classes to employees?	e) Does your worksite offer tobacco cessation classes to employees? Yes	e) Does your worksite offer tobacco cessation classes to employees? No	e) Does your worksite offer tobacco cessation classes to employees? Unknown	e) Does your worksite offer tobacco cessation classes to employees? NA
f) Does your worksite provide any type of incentives for healthy eating?	f) Does your worksite provide any type of incentives for healthy eating? Yes	f) Does your worksite provide any type of incentives for healthy eating? No	f) Does your worksite provide any type of incentives for healthy eating? Unknown	f) Does your worksite provide any type of incentives for healthy eating? NA
g) Does your worksite provide any type of incentives for maintaining ideal weight?	g) Does your worksite provide any type of incentives for maintaining ideal weight? Yes	g) Does your worksite provide any type of incentives for maintaining ideal weight? No	g) Does your worksite provide any type of incentives for maintaining ideal weight? Unknown	g) Does your worksite provide any type of incentives for maintaining ideal weight? NA
h) Does your worksite provide any type of incentives for engaging in physical activity?	h) Does your worksite provide any type of incentives for engaging in physical activity? Yes	h) Does your worksite provide any type of incentives for engaging in physical activity? No	h) Does your worksite provide any type of incentives for engaging in physical activity? Unknown	h) Does your worksite provide any type of incentives for engaging in physical activity? NA

3. Physical Activity

	Yes	No	Unknown	NA
a) Does your worksite offer group physical activities for employees (e.g., office softball, volleyball)?	*Physical Activity a) Does your worksite offer group physical activities for employees (e.g., office softball, volleyball)? Yes	a) Does your worksite offer group physical activities for employees (e.g., office softball, volleyball)? No	a) Does your worksite offer group physical activities for employees (e.g., office softball, volleyball)? Unknown	a) Does your worksite offer group physical activities for employees (e.g., office softball, volleyball)? NA
b) Does your worksite promote using the stairs instead of the elevator?	b) Does your worksite promote using the stairs instead of the elevator? Yes	b) Does your worksite promote using the stairs instead of the elevator? No	b) Does your worksite promote using the stairs instead of the elevator? Unknown	b) Does your worksite promote using the stairs instead of the elevator? NA
c) Does your worksite have locker rooms with showers available for your employees?	c) Does your worksite have locker rooms with showers available for your employees? Yes	c) Does your worksite have locker rooms with showers available for your employees? No	c) Does your worksite have locker rooms with showers available for your employees? Unknown	c) Does your worksite have locker rooms with showers available for your employees? NA
d) Does your worksite have an indoor area set aside specifically for exercise and physical activity?	d) Does your worksite have an indoor area set aside specifically for exercise and physical activity? Yes	d) Does your worksite have an indoor area set aside specifically for exercise and physical activity? No	d) Does your worksite have an indoor area set aside specifically for exercise and physical activity? Unknown	d) Does your worksite have an indoor area set aside specifically for exercise and physical activity? NA
e) Does your worksite have outdoor exercise facilities, such as jogging trails?	e) Does your worksite have outdoor exercise facilities, such as jogging trails? Yes	e) Does your worksite have outdoor exercise facilities, such as jogging trails? No	e) Does your worksite have outdoor exercise facilities, such as jogging trails? Unknown	e) Does your worksite have outdoor exercise facilities, such as jogging trails? NA

4. Cafeteria, Snack Bar, or Food Service

Complete this section only if your worksite has a cafeteria, snack bar or food service. Skip this section if your worksite does not.

For this section, “healthy” food includes low-fat, reduced sodium, no sugar options such as low-fat or fat free yogurt or cheese, lean meat sandwiches, broiled or baked meats or fish, light or fat free mayonnaise or salad dressing, or whole grain breads.

“Healthy” beverage include low-fat or fat free milk, 100% fruit juice, diet drinks, water, and unsweetened teas and coffees.

	Yes	No	Unknown	NA
a) Does your worksite have a cafeteria, snack bar, or food service that provide healthy food alternatives on a daily basis?	*Cafeteria, Snack Bar, or Food Service Complete this section only if your worksite has a cafeteria, snack bar or food service. Skip this section if your worksite does not. For this section, “healthy” food includes low-fat, reduced sodium, no sugar options such as low-fat or fat free yogurt or cheese, lean meat sandwiches, broiled or baked meats or fish, light or fat free mayonnaise or salad dressing, or whole grain breads. “Healthy” beverage include low-fat or fat free milk, 100% fruit juice, diet drinks, water, and unsweetened teas and coffees. a) Does your worksite have a cafeteria, snack bar, or food service that provide healthy food alternatives on a daily basis? Yes	a) Does your worksite have a cafeteria, snack bar, or food service that provide healthy food alternatives on a daily basis? No	a) Does your worksite have a cafeteria, snack bar, or food service that provide healthy food alternatives on a daily basis? Unknown	a) Does your worksite have a cafeteria, snack bar, or food service that provide healthy food alternatives on a daily basis? NA
b) Does your worksite have a cafeteria, snack bar, or food service that provide dried fruit (no-sugar added) on a daily basis?	b) Does your worksite have a cafeteria, snack bar, or food service that provide dried fruit (no-sugar added) on a daily basis? Yes	b) Does your worksite have a cafeteria, snack bar, or food service that provide dried fruit (no-sugar added) on a daily basis? No	b) Does your worksite have a cafeteria, snack bar, or food service that provide dried fruit (no-sugar added) on a daily basis? Unknown	b) Does your worksite have a cafeteria, snack bar, or food service that provide dried fruit (no-sugar added) on a daily basis? NA
c) Does your worksite have a cafeteria, snack bar, or food service that provide fresh fruits and vegetables on a daily basis?	c) Does your worksite have a cafeteria, snack bar, or food service that provide fresh fruits and vegetables on a daily basis? Yes	c) Does your worksite have a cafeteria, snack bar, or food service that provide fresh fruits and vegetables on a daily basis? No	c) Does your worksite have a cafeteria, snack bar, or food service that provide fresh fruits and vegetables on a daily basis? Unknown	c) Does your worksite have a cafeteria, snack bar, or food service that provide fresh fruits and vegetables on a daily basis? NA
d) Does your worksite have a cafeteria, snack bar, or food service that provide healthy beverage alternatives on a daily basis?	d) Does your worksite have a cafeteria, snack bar, or food service that provide healthy beverage alternatives on a daily basis? Yes	d) Does your worksite have a cafeteria, snack bar, or food service that provide healthy beverage alternatives on a daily basis? No	d) Does your worksite have a cafeteria, snack bar, or food service that provide healthy beverage alternatives on a daily basis? Unknown	d) Does your worksite have a cafeteria, snack bar, or food service that provide healthy beverage alternatives on a daily basis? NA
e) Does your worksite have a cafeteria, snack bar, or food service that provide labels (e.g., ‘low fat,’ ‘light,’ ‘heart healthy’) to identify “healthy” food alternatives?	e) Does your worksite have a cafeteria, snack bar, or food service that provide labels (e.g., ‘low fat,’ ‘light,’ ‘heart healthy’) to identify “healthy” food alternatives? Yes	e) Does your worksite have a cafeteria, snack bar, or food service that provide labels (e.g., ‘low fat,’ ‘light,’ ‘heart healthy’) to identify “healthy” food alternatives? No	e) Does your worksite have a cafeteria, snack bar, or food service that provide labels (e.g., ‘low fat,’ ‘light,’ ‘heart healthy’) to identify “healthy” food alternatives? Unknown	e) Does your worksite have a cafeteria, snack bar, or food service that provide labels (e.g., ‘low fat,’ ‘light,’ ‘heart healthy’) to identify “healthy” food alternatives? NA
f) Does your worksite have a cafeteria, snack bar, or food service that provide labels to identify the nutritional value of foods (e.g. calories, fat grams, percent of calories from fat)	f) Does your worksite have a cafeteria, snack bar, or food service that provide labels to identify the nutritional value of foods (e.g. calories, fat grams, percent of calories from fat) Yes	f) Does your worksite have a cafeteria, snack bar, or food service that provide labels to identify the nutritional value of foods (e.g. calories, fat grams, percent of calories from fat) No	f) Does your worksite have a cafeteria, snack bar, or food service that provide labels to identify the nutritional value of foods (e.g. calories, fat grams, percent of calories from fat) Unknown	f) Does your worksite have a cafeteria, snack bar, or food service that provide labels to identify the nutritional value of foods (e.g. calories, fat grams, percent of calories from fat) NA
g) Does your worksite have written policies that require healthy food preparation practices in the cafeteria (steaming, low fat/salt substitutes, limited frying)?	g) Does your worksite have written policies that require healthy food preparation practices in the cafeteria (steaming, low fat/salt substitutes, limited frying)? Yes	g) Does your worksite have written policies that require healthy food preparation practices in the cafeteria (steaming, low fat/salt substitutes, limited frying)? No	g) Does your worksite have written policies that require healthy food preparation practices in the cafeteria (steaming, low fat/salt substitutes, limited frying)? Unknown	g) Does your worksite have written policies that require healthy food preparation practices in the cafeteria (steaming, low fat/salt substitutes, limited frying)? NA
h) Does your worksite have written policies that require healthy food choices in the cafeteria?	h) Does your worksite have written policies that require healthy food choices in the cafeteria? Yes	h) Does your worksite have written policies that require healthy food choices in the cafeteria? No	h) Does your worksite have written policies that require healthy food choices in the cafeteria? Unknown	h) Does your worksite have written policies that require healthy food choices in the cafeteria? NA

5. Vending Machines

Complete this section only if your worksite has a vending machine(s). Skip this section if your worksite does not.

For this section, “healthy” food includes low-fat, reduced sodium, no sugar options such as low-fat or fat free yogurt or cheese, lean meat sandwiches, broiled or baked meats or fish, light or fat free mayonnaise or salad dressing, or whole grain breads.

“Healthy” beverage include low-fat or fat free milk, 100% fruit juice, diet drinks, water, and unsweetened teas and coffees.

	Yes	No	Unknown	NA
a) Does your worksite have vending machines for employees that provide dried or fresh fruits, vegetables, lowfat snacks, or other “healthy” food alternatives?	*Vending Machines Complete this section only if your worksite has a vending machine(s). Skip this section if your worksite does not. For this section, “healthy” food includes low-fat, reduced sodium, no sugar options such as low-fat or fat free yogurt or cheese, lean meat sandwiches, broiled or baked meats or fish, light or fat free mayonnaise or salad dressing, or whole grain breads. “Healthy” beverage include low-fat or fat free milk, 100% fruit juice, diet drinks, water, and unsweetened teas and coffees. a) Does your worksite have vending machines for employees that provide dried or fresh fruits, vegetables, lowfat snacks, or other “healthy” food alternatives? Yes	a) Does your worksite have vending machines for employees that provide dried or fresh fruits, vegetables, lowfat snacks, or other “healthy” food alternatives? No	a) Does your worksite have vending machines for employees that provide dried or fresh fruits, vegetables, lowfat snacks, or other “healthy” food alternatives? Unknown	a) Does your worksite have vending machines for employees that provide dried or fresh fruits, vegetables, lowfat snacks, or other “healthy” food alternatives? NA
b) Does your worksite have vending machines for employees that provide "healthy" beverage alternatives (e.g. 100%fruit juice, low-fat milk, diet soda, unsweetened teas or coffee)?	b) Does your worksite have vending machines for employees that provide "healthy" beverage alternatives (e.g. 100%fruit juice, low-fat milk, diet soda, unsweetened teas or coffee)? Yes	b) Does your worksite have vending machines for employees that provide "healthy" beverage alternatives (e.g. 100%fruit juice, low-fat milk, diet soda, unsweetened teas or coffee)? No	b) Does your worksite have vending machines for employees that provide "healthy" beverage alternatives (e.g. 100%fruit juice, low-fat milk, diet soda, unsweetened teas or coffee)? Unknown	b) Does your worksite have vending machines for employees that provide "healthy" beverage alternatives (e.g. 100%fruit juice, low-fat milk, diet soda, unsweetened teas or coffee)? NA
c) Does your worksite have vending machines for employees that provide labels that indicate nutritional value of snacks and beverages on or near the vending machines?	c) Does your worksite have vending machines for employees that provide labels that indicate nutritional value of snacks and beverages on or near the vending machines? Yes	c) Does your worksite have vending machines for employees that provide labels that indicate nutritional value of snacks and beverages on or near the vending machines? No	c) Does your worksite have vending machines for employees that provide labels that indicate nutritional value of snacks and beverages on or near the vending machines? Unknown	c) Does your worksite have vending machines for employees that provide labels that indicate nutritional value of snacks and beverages on or near the vending machines? NA
d) Does your worksite have vending machines for employees that provide labels on or near the vending machines that indicate “healthy” beverage and snack alternatives are available?	d) Does your worksite have vending machines for employees that provide labels on or near the vending machines that indicate “healthy” beverage and snack alternatives are available? Yes	d) Does your worksite have vending machines for employees that provide labels on or near the vending machines that indicate “healthy” beverage and snack alternatives are available? No	d) Does your worksite have vending machines for employees that provide labels on or near the vending machines that indicate “healthy” beverage and snack alternatives are available? Unknown	d) Does your worksite have vending machines for employees that provide labels on or near the vending machines that indicate “healthy” beverage and snack alternatives are available? NA
e) Does your worksite have written policies that require healthy food choices in the vending machines?	e) Does your worksite have written policies that require healthy food choices in the vending machines? Yes	e) Does your worksite have written policies that require healthy food choices in the vending machines? No	e) Does your worksite have written policies that require healthy food choices in the vending machines? Unknown	e) Does your worksite have written policies that require healthy food choices in the vending machines? NA