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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.

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* 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.

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* 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.

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

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

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

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

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

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* 8. 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)

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* 9. 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?

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* 10. 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?

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

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

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

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

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

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

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

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

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* 19. How would you rate your sleep?

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

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

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

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

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* 22. 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?

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* 23. 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

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

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* 25. How (if any) do you experience musculoskeletal pain?

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* 26. If you experience regular musculo-skeletal pain, please specify area and add any detail.

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* 27. How many caffeinated drinks do you consume daily? Include coffee and energy drinks.

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* 28. How many glasses of water do you consume daily?

0 of 28 answered
 

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