In order to best serve your needs, please take time to fill out this needs assessment questionnaire for the new City of Carlsbad Wellness Program. We are in the process of developing a comprehensive wellness program and we need a response from everyone to ensure that the program meets the needs and interests of our workforce. We value your input - it is important to us! (As always, your responses are confidential.)

This 5 minute survey should be completed at one time. You will not be able to save your responses and resume at another time. In addition, you can complete the survey from a smart phone.

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* 1. What City of Carlsbad department do you work for?

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* 2. What is your gender?

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* 3. What is your age?

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* 4. What is your preferred method of communication for upcoming programs and events?

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* 5. Please indicate the organizational need and personal need for each of  the following educational programs

  Workplace Needs This I Need This
Back Safety
Cancer Prevention
Heart Disease Prevention
Stroke Prevention Programs
Cholesterol Reduction
Diabetes Prevention
Nutrition
Home Safety
Substance Abuse
Headache Prevention & Treatment
Cold / Flu Prevention & Treatment
Ergonomics
Using Fitness Equipment
Weight Management

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* 6. Please indicate the organizational need and personal need for each of  the following Physical Activity Programs:

  Workplace Needs This I Need This
Corporate Physical Activity Membership Rates
Exercise Testing (sub-maximal)
On-Site Exercise Equipment
Prescribed Exercise Programs
Stretching / Flexibility Programs / Yoga
Walking Group
Running Group
Cycling Group
Core Training
Zumba
Massage Therapy

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* 7. What are your current exercise intentions?

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* 8. Which of the following best represents your interest in Group Exercise?

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* 9. What time would be Best for you to participate in an exercise or fitness class?

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* 10. Please indicate the organizational need and personal need for each of  the following Nutrition Programs:

  Workplace Needs This I Need This
Healthy Cooking (meals/snacks)
Healthy Eating (do's & don'ts)
Weight Management Programs (diet & exercise)
Onsite Vending Machines with Healthy Choices
Healthy Meetings
Disease Management Programs

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* 11. Please indicate the organizational need and personal need for each of  the following Screening Programs:

  Workplace Needs This I Need This
Blood Pressure Checks
Blood Glucose / A1C Testing (Blood Glucose Levels over the past 3 months)
Cholesterol Levels
Body Fat Testing
Cardiovascular (EKG's)
Colon / Rectal (cancer)
Prostate Checks (PSA)
Mammograms
Vision
Hearing Screening
Waist Circumference / Body Mass Index
Bone Mineral Density

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* 12. Please indicate the organizational need and personal need for each of  the following employee assistance programs:

  Workplace Needs This I Need This
Depression and Mental Health Screening / Treatment
Financial Management
Stress Reduction Programs
Parenting Successfully / Dependent Care
Managing Chronic Health Conditions (diabetes, hypertension...)
Controlling Anger / Emotions
Work / Life Balance
Mindfulness
Tobacco Dependence / Smoking Cessation

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* 13. What day(s) of the week would be most convenient to attend wellness seminars or programs?

  8:00 a.m. 12:00 p.m. 1:00 p.m. 5:00 p.m. 6:00 p.m.
Monday
Tuesday
Wednesday
Thursday
Friday

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* 14. Do you get a physical from your Doctor once a year?

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* 15. Would you take advantage of consulting with a Wellness Specialist to help you develop a nutrition and/or exercise program?

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* 16. If an online video library with various health topics was available, would you use this service?

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* 17. Please tell us anything else you are looking for in a wellness program.

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