Screen Reader Mode Icon

Entry Survey

None of the results or data will be linked back to the individual. It will only be looked at as a whole staff response with no names or identities attached.

Question Title

* 1. How many serves of vegetables do you consume each day? (including fresh, dried, frozen and tinned) 1 serve = 1 cup of salad or half a cup of cooked vegetables.

Question Title

* 2. How many serves of fruit do you consume each day? (including fresh, dried, frozen and tinned) 1 serve = 1 medium sized peice of fruit/ 1 cup of canned or chopped fruit/ 1 1/2 tablespoons of dried fruit.

Question Title

* 3. Have you had an alcoholic drink of any kind in the last 12 months.

Question Title

* 4. On a day that you would have an alcoholic drink how many standard drinks do you usually have?

Question Title

* 5. In the last 12 months, how often have you had more than 4 drinks on one occassion 

Question Title

* 6. Which of the following is applicable to you.

Question Title

* 7. Do you smoke regularly, that is at least once a day?

Question Title

* 8. In the last 12 months have you successfully given up smoking for more than a month?

Question Title

* 9. In the last 12 months have you tried to give up smoking but been unsuccessful?

Question Title

* 10. In the last week how many times have you walked continuously for at least 10 minutes (for recreation, exercise or to get from place to place)

Question Title

* 11. In the last week how many times did you do vigourous activity around the home or at work such as lifting or gardening that made you breathe harder or puff and pant?

Question Title

* 12. EXCLUDING HOUSEHOLD CHORES AND WORK
How many times did you do purposeful cardiovascular exercise in the last week, that made you breathe harder or puff and pant?

Question Title

* 13. EXCLUDING HOUSEHOLD CHORES OR WORK
How many times did you do purposeful strengthening or toning excersise in the last week?

Question Title

* 14. How often do you attend social or recreational activities for enjoyment? (e.g. lawn bowls, book club, coffee with a friend etc.)

Question Title

* 15. What is the time you spend sitting on a typical work day?

Question Title

* 16. What is the time you spend sitting on a non-work day?

Question Title

* 17. Which of the following behaviours would you most like to change in the next 6-12 months?

Question Title

* 18. What type of exercise/activity would you prefer to engage in? (number the boxes 1 being most preferred 5 being least preferred)

Question Title

* 19. In general would you say your health is:

Question Title

* 20. Do you have a pre existing medical condition?

Question Title

* 21. How would you rate your sleep?

Question Title

* 22. How satisfied are you with your life as a whole?

0 Neutral 10
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 23. How satisfied are you with your work life?

0 Neutral 10
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 24. How would you rate the level of stress you have experienced in your job in the last 12  months?

0 10
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 25. How would you rate your relationship with your supervisors?

Question Title

* 26. How would you rate your relationship with your immediate co-workers?

Question Title

* 27. Managing time is difficult. How often do you feel..

  Never About once a month About once a week A few times a week Every day
That you are rushed pressured or too busy?
That you have time on your hands?

Question Title

* 28. Please indicate how often you've felt each of the following in the past 6 months  (1 is not at all, 7 is all the time).

  7 6 5 4 3 2 1
My personal life suffers because of work
My job makes my personal life difficult
I neglect my personal needs because I am too busy
I put my personal life on hold for work commitments
I struggle to juggle my commitments
My personal life drains me of energy for my work
I am too tired to be effective at work
My work suffers because of my personal life
I find it hard to work because of personal matters

Question Title

* 29. In the last 6 months how often has your work been affected by your..

  A lot of the time Some of the time A little of the time None of the time
Physical health
Emotional or psycological wellbeing

Question Title

* 30. How would you rate your resilience when things go wrong?

0 of 30 answered
 

T