Supportive environments significantly increase the likelihood that positive changes in health behavior will take place.

This 'checklist' serves as a good way to measure and track changes you may make over time. There are no right or wrong answers. Your responses will not only help our "Healthworks" team understand the unique needs and interests or your organization, but will help us identify where we may be able to offer resources and support as you move forward with your worksite program.

* 1. Your name:

* 2. Your Organization:

* 3. Your Contact Information (email & phone number)

* 4. How many locations does your organization have? What states/countries?

* 5. How many total employees do you have?

* 6. How many of your employees are covered under your medical plan?

* 7. Who is your current medical carrier?

* 9. Who is your occupational health vendor?

* 10. Who is your workers compensation carrier?

* 12. Does your CEO allocate the resources necessary to operate and sustain a wellness initiative (budget, incentives etc.)

* 13. Does your organization incentivize employees through premium differentials?

* 14. Do you have wellness team/committee?

* 15. Which of the following have you offered at your workplace? Check all that apply.

* 16. What kind of wellness programs/goals do you have in mind for the next 12 months?