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Be Well would like to know the current status of your wellness and physical activities to improve our Be Well Employee Wellness Program. Your honest answers will help Be Well evaluate program goals and objectives. Your name and contact information are NOT submitted with this survey: your responses are anonymous.

This survey is for employees of the Town of Mansfield, Mansfield BOE, and Region 19.

You do not need to be enrolled in Be Well Rewards to take this survey, but if you are, you will earn 1 point at completion. At the end of the survey you will be directed to a separate page to register your name - but it will not be linked to your survey responses. 

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* 1. Who is your Employer?

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* 2. What is your current age?

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* 3. In an average week, how many days do you participate in 30 minutes of physical activity that cause increases in breathing or heart rate? (check only one)

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* 4. If Be Well was not able to offer physical activity programs do you feel you would be able to find them on your own?

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* 5. Do you currently use any type of nicotine product? (check all) If no, skip to Question 7.

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* 6. How interested are you in quitting nicotine? (check only one)

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* 7. How often do you participate in meditation or stress reducing activities?

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* 8. Based on the chart (click here) are you overweight for your height?

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* 9. If you are overweight, in the past 12 months have you been successful in reducing your weight?

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* 10. In which of the following categories would you place yourself?

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* 11. If you could receive information for five of the health topics listed below, which would you select? (check up to 5)

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* 12. If it was a topic of interest to you, which format would be the most appealing to you? (pick up to two)

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* 13. How long would you like a wellness activity to last? (not physical activity)

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* 14. Would you participate in any of the following wellness activities if available? (check all that apply)

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* 15. Where do you obtain most of your preventive health care screenings (Cholesterol, Blood Pressure, Body Mass Index, Blood Sugar levels)?

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* 16. Where are you most likely to participate in wellness (not just fitness) activities? (check all that apply)

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* 17. When would you most likely participate in wellness activities? (check all that apply)

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* 18. Which of the following incentives would increase your likelihood to participate in wellness(not just fitness) activities? (Check all that apply.)

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* 19. Are there any barriers that prevent you from participating in wellness activities? (Check all that apply.)

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* 20. What is the best way for your worksite to help you overcome these barriers?

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* 21. What do you see as the biggest challenge to you meeting your health goals, not related to your worksite?

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* 22. How would you prefer to receive information about Be Well events? (Check up to two answers.)

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* 23. Please rate how helpful the Be Well program has been in helping you reach your wellness goals?

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* 24. Please rate the Be Well Team on the following criteria:

  Excellent Very Good Average Below Average Not Applicable
Professionalism
Courtesy
Helpfulness
Overall Customer Service
To earn your Reward Point from Be Well, please follow the instructions below.

DO NOT CLICK THE DONE BUTTON YET! - Once you have clicked the done button you will not be able to get back into the survey.   

Open a new tab or web page and paste this web address into it first www.surveymonkey.com/r/5WJ5HCP
or CLICK HERE

Then return to this survey and hit the DONE button.

*you do not need to out an answer in the box below.  Survey monkey only allows us to insert questions.

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