Palm Springs Unified School District Employee Wellbeing Survey

Please complete the survey in order to receive a free T-Shirt

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your email address?

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* 4. What site do you work at?

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* 5. Select your T-Shirt size

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* 6. What is your gender?

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* 7. I exercise at least 20 minutes a day

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* 8. I often eat on the run and skip meals

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* 9. I avoid eating foods high in fat

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* 10. I make an effort to eat enough high fiber foods

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* 11. I eat high quality breakfast everyday

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* 12. I am about the right weight

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* 13. I would like to lose weight

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* 14. I am more than 20 pounds overweight

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* 15. I usually get seven to eight hours of sleep a night

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* 16. I average at least two nights a week where I don't get enough sleep

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* 17. I often find it hard to get enough sleep

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* 18. I regularly practice some type of stress management

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* 19. I have trouble balancing life and work

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* 20. I usually consult a medical self-care source when sick

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* 21. I prefer taking Rx drugs over making lifestyle changes

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* 22. Would you be willing to be a Wellness Champion at your school site?

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* 23. In which of the following activities would you consider participating (check all that apply):

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* 24. Are you currently enrolled in a weight loss program?

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* 25. When would you be most likely to participate? (check all that apply)

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* 26. Would you be willing to share a small cost for participating in these programs?

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* 27. Would you be interested in plans which include family members?

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* 28. What is the best way for the work site to help employees be healthier?

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* 29. Overall, how would you rate the event?

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