Exit this survey 12 Staircases of December - 2016 Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Gender Male Female Other Question Title * 4. Please indicate faculty or staff. Faculty Staff Question Title * 5. Please enter your 9-digit staff ID # (found on your BruinCard): Question Title * 6. Department Question Title * 7. Email Question Title * 8. Do you pledge to take the stairs more often from 12/1 to 12/16? Yes No No, but I will engage in activities that best suit my abilities Question Title * 9. Do you plan to attend at least one of the designated staircase challenges from 12/1 to 12/16? Yes No Yes, and I look forward to an alternate workout that best suits my abilities Question Title * 10. To be eligible for a 12 Staircase Challenge embroidered UCLA scarf, you must attend at least 4 of the campus challenge locations . Please indicate the days you plan to attend. We encourage you to attend as many as you can for your health and for more chances to win the GRAND PRIZE. Thursday, 12/1, Anderson School of Business Steps, 11a-1p Friday, 12/2, Biomedical Building Staircase, 11a-1p Monday, 12/5, Melnitz Staircase, 11a-1p Tuesday, 12/6, Franz Hall Staircase, 11a-1p Wednesday, 12/7, UNEX Staircase @ Gayley & Le Conte Ave, 11a-1p Thursday, 12/8, Bunch Hall Staircase, 11-1p Friday, 12/9, CHS Staircase (School of Public Health), 11a-1p Monday, 12/12, Broad Hall Steps, 11a-1p Tuesday, 12/13, La Kretz Staircase or *Wilshire Center Staircase (*for Wilshire Center employees only), 11a-1p Wednesday, 12/14, Drake Stadium Stairs, 11a-1p Thursday, 12/15, Gonda Stairs (across from the Police Station), 11a-1p Friday, 12/16, Janss Steps, 11-1p Question Title * 11. Are you currently a member of UCLA Recreation? If not check out our great packages at www.recreation.ucla.edu/newmembers Yes No Question Title * 12. In order to complete your registration, please read the following waiver HERE and indicate below that you have read and understood this document by typing your full name. The following questions are optional, however these questions are geared toward collecting data that will help to develop and improve FITWELL Programs for Faculty and Staff. Responses are confidential and will not be shared. Question Title * 13. On average, how would you describe your energy level? Not Energized Slightly Energized Somewhat Energized Energized Very Energized Not Energized Slightly Energized Somewhat Energized Energized Very Energized Question Title * 14. On average, how would you rate your ability to cope with daily stress? Very high High Medium Low Very low Very high High Medium Low Very low Question Title * 15. Over the past week, have many times have you engaged in any type of physical activity for more than 30 minutes? (walking, gardening, cleaning, etc.) 1 or Less 2-5 6 or More Question Title * 16. In which of the following categories would you place yourself? I'm not interested in pursuing a healthy lifestyle. I have been thinking about changing some of my health behaviors. I am planning on making a health behavior change within the next 30 days. I have made some health behavior changes, but I still have trouble following them. I have had a healthy lifestyle for years. Question Title * 17. Which of the following FITWELL programs have you participated in? Check all that apply. FIT Sports Bruin Health Improvement Program (BHIP/BHIP.5) FITWELL Edu (fitness education at your department work site) FitZone Classes (free Tai Chi & Qi Gong, Total Body Strength, Yoga, ABDC) Chair Massage Personal Fitness Training Bruin MindFit FitBreaks Warm Up to Work Have not participated in FITWELL Programs Other, please specify: Submit