This Challenge has been developed to assist workplaces to implement a health and wellness programme. It encourages workplaces to provide a supportive smoke-free environment and healthy policies for employees that promote physical activity, healthy eating, and mental wellbeing.

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* 1. Contact Person *

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* 2. Business/Organization Name *

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* 3. Address: *

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* 4. Work Phone #: *

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* 5. Cell Phone #: *

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* 6. Email Address: *

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* 7. Number of Employees: *

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* 8. Do you collect data related to employee health? *

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* 9. How would you rate the overall health of your employees? *

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* 10. To what extent does senior management actively support employee health improvement? *

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* 11. Do you have an existing Wellness Programme? *

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* 12. Do you have a wellness plan? *

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* 13. Do you have a Wellness Coordinator? *

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* 14. Do you have a wellness committee? *

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* 15. Does your company offer health insurance? *

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* 16. How did you hear about the Healthy Business Challenge? Please select all that apply.

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