INSTRUCTIONS: Employees are encouraged to nominate a colleague who models a health lifestyle, has made positive changes in health behaviors, or motivates others to make health improvements. Please respond to the following questions in complete and specific terms that are related to the nomination. Give precise examples of why you feel this person should be the Workplace Wellness Champion. All DSS employees are eligible for this award.

Please note: Nominations must not contain any personal health information regarding the employee, such as references to weight loss, conditions, injuries, etc., without consent of the employee. Please know that if your nomination contains such information, the employee will be contacted for consent.

Refer to DSS Policy 2-201 (Workplace Wellness Program) for additional information.

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