Wellness Site Check-In

This survey is specifically crafted for you to capture the specific needs and opportunities at your work location. By sharing your perspective, you'll help Healthy Lifestyles tailor our wellness programs to better serve our diverse organization.

Question Title

* 1. Name of person completing check-in:

Question Title

* 2. EIN:

Question Title

* 3. Salt Lake County Department

Question Title

* 4. Location Name & Address

Question Title

* 5. Number of Employees at Location (answer to the best of your ability)

	0-49	50-99	100-199	200-299	300+
Benefits Eligible	Benefits Eligible 0-49	Benefits Eligible 50-99	Benefits Eligible 100-199	Benefits Eligible 200-299	Benefits Eligible 300+
Non-Benefits Eligible	Non-Benefits Eligible 0-49	Non-Benefits Eligible 50-99	Non-Benefits Eligible 100-199	Non-Benefits Eligible 200-299	Non-Benefits Eligible 300+

Additional Comments:

Question Title

* 6. Physical Activity: Encouraging regular movement to improve overall physical health within the workplace.

	Yes	Sometimes	No
Are group exercise classes available or are there nearby gyms and recreation centers?	Are group exercise classes available or are there nearby gyms and recreation centers? Yes	Are group exercise classes available or are there nearby gyms and recreation centers? Sometimes	Are group exercise classes available or are there nearby gyms and recreation centers? No
Is there a safe area outside for walking?	Is there a safe area outside for walking? Yes	Is there a safe area outside for walking? Sometimes	Is there a safe area outside for walking? No
Are walking/standing workstations available?	Are walking/standing workstations available? Yes	Are walking/standing workstations available? Sometimes	Are walking/standing workstations available? No
Is there promotion and participation in physical wellness challenges such as March Into May?	Is there promotion and participation in physical wellness challenges such as March Into May? Yes	Is there promotion and participation in physical wellness challenges such as March Into May? Sometimes	Is there promotion and participation in physical wellness challenges such as March Into May? No
Is physical activity part of the regular job duties at this location?	Is physical activity part of the regular job duties at this location? Yes	Is physical activity part of the regular job duties at this location? Sometimes	Is physical activity part of the regular job duties at this location? No
Is the HealthyMe Clinic promoted to employees and their spouses?	Is the HealthyMe Clinic promoted to employees and their spouses? Yes	Is the HealthyMe Clinic promoted to employees and their spouses? Sometimes	Is the HealthyMe Clinic promoted to employees and their spouses? No
Is there encouragement to take walking meetings or movement breaks?	Is there encouragement to take walking meetings or movement breaks? Yes	Is there encouragement to take walking meetings or movement breaks? Sometimes	Is there encouragement to take walking meetings or movement breaks? No
Are employees aware of the recreation center discount for county employees & their families?	Are employees aware of the recreation center discount for county employees & their families? Yes	Are employees aware of the recreation center discount for county employees & their families? Sometimes	Are employees aware of the recreation center discount for county employees & their families? No

Additional Comments:

Question Title

* 7. Mental Health: Prioritizing mental well-being by offering resources, support, and awareness around stress management, mental health issues, and work-related stress.

	Yes	Sometimes	No
Are there promotions for the VEST Employee Assistance Program?	Are there promotions for the VEST Employee Assistance Program? Yes	Are there promotions for the VEST Employee Assistance Program? Sometimes	Are there promotions for the VEST Employee Assistance Program? No
Are there any promotions for Mindful Moments through Healthy Lifestyles?	Are there any promotions for Mindful Moments through Healthy Lifestyles? Yes	Are there any promotions for Mindful Moments through Healthy Lifestyles? Sometimes	Are there any promotions for Mindful Moments through Healthy Lifestyles? No
Has there been any employee satisfaction surveys conducted to assess mental well-being?	Has there been any employee satisfaction surveys conducted to assess mental well-being? Yes	Has there been any employee satisfaction surveys conducted to assess mental well-being? Sometimes	Has there been any employee satisfaction surveys conducted to assess mental well-being? No
Are there any Suicide Prevention Resources/988 services promoted?	Are there any Suicide Prevention Resources/988 services promoted? Yes	Are there any Suicide Prevention Resources/988 services promoted? Sometimes	Are there any Suicide Prevention Resources/988 services promoted? No
Has QPR (Question, Persuade, Refer) training been provided to employees?	Has QPR (Question, Persuade, Refer) training been provided to employees? Yes	Has QPR (Question, Persuade, Refer) training been provided to employees? Sometimes	Has QPR (Question, Persuade, Refer) training been provided to employees? No
Are there promotions for mental health programs/workshops offered through Healthy Lifestyles?	Are there promotions for mental health programs/workshops offered through Healthy Lifestyles? Yes	Are there promotions for mental health programs/workshops offered through Healthy Lifestyles? Sometimes	Are there promotions for mental health programs/workshops offered through Healthy Lifestyles? No

Question Title

* 8. Tobacco Prevention: Promotion of programs and resources to support employees in quitting smoking and reducing tobacco use.

	Yes	Sometimes	No
Are there promotions for Healthy Lifestyles tobacco cessation program?	Are there promotions for Healthy Lifestyles tobacco cessation program? Yes	Are there promotions for Healthy Lifestyles tobacco cessation program? Sometimes	Are there promotions for Healthy Lifestyles tobacco cessation program? No
Does your location enforce a tobacco-free campus?	Does your location enforce a tobacco-free campus? Yes	Does your location enforce a tobacco-free campus? Sometimes	Does your location enforce a tobacco-free campus? No
Is there appropriate signage that states the worksite is a tobacco-free campus?	Is there appropriate signage that states the worksite is a tobacco-free campus? Yes	Is there appropriate signage that states the worksite is a tobacco-free campus? Sometimes	Is there appropriate signage that states the worksite is a tobacco-free campus? No

Additional Comments:

Question Title

* 9. Nutrition: Promoting balanced diets and mindful food choices to support employee well-being and energy levels.

	Yes	Sometimes	No
Are employees provided nutrient-dense food options through vending machines and catered events?	Are employees provided nutrient-dense food options through vending machines and catered events? Yes	Are employees provided nutrient-dense food options through vending machines and catered events? Sometimes	Are employees provided nutrient-dense food options through vending machines and catered events? No
Would you be interested in a healthy meal vending machine like those offered by Hello Fresh? (Yes or NO	Would you be interested in a healthy meal vending machine like those offered by Hello Fresh? (Yes or NO Yes	Would you be interested in a healthy meal vending machine like those offered by Hello Fresh? (Yes or NO Sometimes	Would you be interested in a healthy meal vending machine like those offered by Hello Fresh? (Yes or NO No
Is there promotion of nutrition education resources or workshops offered through Healthy Lifestyles?	Is there promotion of nutrition education resources or workshops offered through Healthy Lifestyles? Yes	Is there promotion of nutrition education resources or workshops offered through Healthy Lifestyles? Sometimes	Is there promotion of nutrition education resources or workshops offered through Healthy Lifestyles? No
Do employees have access to spaces where they can safely store, prepare, or reheat their own food?	Do employees have access to spaces where they can safely store, prepare, or reheat their own food? Yes	Do employees have access to spaces where they can safely store, prepare, or reheat their own food? Sometimes	Do employees have access to spaces where they can safely store, prepare, or reheat their own food? No

Additional Comments:

Question Title

* 10. Work-Life Balance: Fostering an environment that supports employees in maintaining a healthy equilibrium between work responsibilities and personal life commitments.

	Yes	No
Is there a designated area for nursing mothers and/or a Mother’s Room?	Is there a designated area for nursing mothers and/or a Mother’s Room? Yes	Is there a designated area for nursing mothers and/or a Mother’s Room? No
Is the average turnover rate higher than 25%?	Is the average turnover rate higher than 25%? Yes	Is the average turnover rate higher than 25%? No
If employees participate in Healthy Lifestyles events, are they compensated for their time?	If employees participate in Healthy Lifestyles events, are they compensated for their time? Yes	If employees participate in Healthy Lifestyles events, are they compensated for their time? No
Is there an employee recognition program offered?	Is there an employee recognition program offered? Yes	Is there an employee recognition program offered? No

Additional Comments:

Question Title

* 11. What are the general working hours and break times for employees at this location?

General Working Hours:

Break/Lunch Times:

Question Title

* 12. Health Screenings & Preventive Care: Providing access to screenings, check-ups, and preventive health measures to detect and address potential health concerns early on.

	Yes	Somewhat	No
Are annual physicals and vaccinations promoted and encouraged?	Are annual physicals and vaccinations promoted and encouraged? Yes	Are annual physicals and vaccinations promoted and encouraged? Somewhat	Are annual physicals and vaccinations promoted and encouraged? No
Is your location fully compliant with all relevant health and safety regulations?	Is your location fully compliant with all relevant health and safety regulations? Yes	Is your location fully compliant with all relevant health and safety regulations? Somewhat	Is your location fully compliant with all relevant health and safety regulations? No

Please provide additional information or details to elaborate.

Question Title

* 13. Social Support / Diversity & Inclusion: Creating a supportive community network within the workplace that embraces and celebrates individual differences while ensuring equal opportunities and fair treatment for all employees.

	Yes	Somewhat	No
Are employees encouraged to participate in corporate games?	Are employees encouraged to participate in corporate games? Yes	Are employees encouraged to participate in corporate games? Somewhat	Are employees encouraged to participate in corporate games? No
Are there volunteer or community service opportunities offered?	Are there volunteer or community service opportunities offered? Yes	Are there volunteer or community service opportunities offered? Somewhat	Are there volunteer or community service opportunities offered? No
Do employees regularly participate in worksite team building and wellness activities?	Do employees regularly participate in worksite team building and wellness activities? Yes	Do employees regularly participate in worksite team building and wellness activities? Somewhat	Do employees regularly participate in worksite team building and wellness activities? No
Is there promotion of a supportive and inclusive work environment?	Is there promotion of a supportive and inclusive work environment? Yes	Is there promotion of a supportive and inclusive work environment? Somewhat	Is there promotion of a supportive and inclusive work environment? No
Is the Parent Support Group offered through Healthy Lifestyles promoted?	Is the Parent Support Group offered through Healthy Lifestyles promoted? Yes	Is the Parent Support Group offered through Healthy Lifestyles promoted? Somewhat	Is the Parent Support Group offered through Healthy Lifestyles promoted? No
Do employees at this worksite feel safe being their authentic selves?	Do employees at this worksite feel safe being their authentic selves? Yes	Do employees at this worksite feel safe being their authentic selves? Somewhat	Do employees at this worksite feel safe being their authentic selves? No

Additional Details/Comments:

Question Title

* 14. Which factors at this location may influence employee health?

Question Title

* 15. Which dimensions of wellness are strongest at this location?

Cultural

Physical

Occupational

Mental

Social

Spiritual

Intellectual

Environmental

Financial

Question Title

* 16. Which dimensions of wellness at this location can be improved?

Cultural

Physical

Occupational

Mental

Social

Spiritual

Intellectual

Environmental

Financial

Question Title

* 17. What are some topics employees at your location would be interested in learning about?

Question Title

* 18. If employees were to attend an Healthy Lifestyles event, class, or workshop nearby, which time and day would be most preferable?

Question Title

* 19. What are some obstacles employees face in accessing Healthy Lifestyles programs, activities, classes, workshops, and events? (Select all that apply.)

Too much work

Not enough support/insufficient coverage in the office

Insufficient supplies or equipment

Workplace distractions

Personal distractions

Other/Additional Comments

Question Title

* 20. What are some obstacles employees face in improving their health & wellness? (Select all that apply.)

Too much work

Not enough support

Insufficient supplies or equipment

Workplace distractions

Personal distractions

Other/Additional Comments

Question Title

* 21. What are the best ways to provide employees with information about Healthy Lifestyles?

eConnect

Bulletin Board

At Home Mailings

Text

Other

Other (please specify)

Question Title

* 22. Is there any other pertinent information you'd like to share about your location?

Thank you for being the catalyst for change and fostering a culture of wellness at your site! Your input will directly influence a healthier, more supportive workplace environment for all.