YCT Wellness Program - Health Risk Assessment (HRA)

Introduction

Thank you in advance for completing the Health Risk Assessment (HRA), which is an important part of the YCT Wellness Incentive Program. Our Wellness Program is interested in your health and wellness, and the quality of your medical care. Please select only one response per question.

The HRA is a screening tool used to identify potential risk factors that can affect your health and quality of life. Risk factors are things that increase or decrease the risk of developing a disease. They can be lifestyle factors such as diet and activity level, environmental factors such as air pollution, or personal characteristics such as family history, race, or age.

The HRA is not a substitute for a checkup or physical exam that you get from a doctor or nurse. However, it can give you some ideas for lowering your risk factors.

The information you share in your HRA is private. Only the YCT Wellness Coordinator will have access to the results, and these results will be in aggregate data form only. No names will be used. We cannot and will not give anyone else your HRA information. Completing your HRA does not affect where or from whom you can seek care.

Please check the box beside the number which best identifies your response to each corresponding statement.
1. Never or Almost Never
2. Occasionally
3. Often
4. Very Often
5. Always or Almost Always

Question Title

* 1. Your employer:

City of Prescott

Yavapai County

Town of Chino Valley

Yavapai College

Physical Activity

Question Title

* 2. I engage in moderate physical activity outside of work for at least 20 to 30 minutes at least 5 days of the week.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 3. My physical activity includes stretching, aerobic activity, and strength conditioning.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 4. I use alternative modes of transportation whenever possible to and from various locations (stairs instead of elevator, biking or walking instead of driving).

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 5. I take the health benefits of physical activities and their lasting impact seriously.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 6. I enjoy sedentary activities rather than physical activities.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

Nutrition

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* 7. I eat at least five servings of fruits and vegetables every day (one serving equals one half cup).

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 8. I eat at fast food restaurants less than three times per week.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 9. I maintain a healthy weight within the recommendations specified by a health care professional.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 10. I avoid eating foods that are high in fat such as fried foods, fatty meats, etc.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

General Health

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* 11. I avoid the use of tobacco products (cigarettes, smokeless tobacco, cigars, and pipes) and limit myself to 5 drinks of alcohol a week. (beer, liquor, wine)

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 12. I examine my breasts or testes on a monthly basis.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 13. I protect my skin from sun damage by using sunscreen, wearing hats, and/or avoiding tanning booths and sunlamps.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 14. I visit my dentist every six months for regular checkups.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 15. I see my physician for routine check-ups, health screenings, and disease prevention.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

Safety

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* 16. I wear a seat belt when traveling in a vehicle.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 17. I stay within five miles per hour of the speed limit.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 18. I know where to locate and properly use a first aid kit and fire extinguisher in case of an emergency.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 19. I use the recommended safety equipment for all activities that I participate in (mouth guards, life jackets, hard hats).

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 20. I take the proper precautions to avoid or reduce workplace accidents.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

Social and Environmental Wellness

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* 21. I regularly recycle my paper, plastic, glass and aluminum.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 22. I respect the integrity and property of my fellow co-workers and the surrounding environment.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 23. I take time to have meaningful interactions with family and friends.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 24. I contribute time and/or money to at least one organization that strives to better the community where I live.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 25. I regularly take interest in and interact with others.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

Emotional Awareness

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* 26. My relationships and behaviors are maintained in a manner which is healthy for me and for others.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 27. I am able to develop close, personal relationships with others.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 28. I have positive relationships with both men and women in my life.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 29. I feel that I am a confident individual.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 30. I am able to respect others for who they are, regardless of race, gender, age, attitude, and interests.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

Mental Wellness

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* 31. I set reasonable objectives for myself and strive to accomplish them.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 32. I realize when I make mistakes and I understand the consequences that they have on myself and others.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 33. I feel that I have family and friends that I can confide in to assist in managing stress.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 34. I take responsibility for my actions and understand the effects that they have on others.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

Intellectual Wellness

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* 35. I keep informed about social, political, and/or current events.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 36. I seek opportunities to learn new things through different mediums such as television, books, newspaper, internet, etc.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 37. Before making decisions, I gather facts and consider all viable options.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 38. I enjoy activities such as the arts, visiting museums, or attending plays or concerts.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 39. I enjoy learning new information on a daily basis.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

Occupational Wellness

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* 40. I enjoy my work.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 41. I am satisfied with the balance between my work time and leisure time.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 42. I am satisfied with my ability to manage and control my workload.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 43. The level of stress in my work environment is manageable for me.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 44. At work, my level of authority is consistent with my level of responsibility.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

Values and Beliefs

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* 45. I feel that my life has a purpose.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 46. I am able to discuss my values and beliefs with my family and friends in a reasonable manner.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 47. My actions are guided by my own beliefs rather than the beliefs of others.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 48. I spend a portion of every day in personal reflection.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

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* 49. I am tolerant of the values and beliefs of others.

1 Never

2 Occasionally

3 Often

4 Very often

5 Always

To receive credit for taking part in this survey, please email Paula Tomitz with your contact information..

Paula Tomitz
YCT Wellness Coordinator
Paula.Tomitz@yc.edu