Worksite Wellness Question Title * 1. Are you open to healthy changes in the workplace? Yes No If yes, would you participate in a wellness program if offered to you at work? (Ex: Health promotion activity to support and encourage healthy choices and improve health outcomes at work and home). (Select if yes. If no, leave blank). Question Title * 2. If you are interested in participating in wellness activities, what time of day are you willing to participate? Before Work After Work At Lunchtime At home activities with accountability challenges Question Title * 3. What is your favorite form of physical activity? Walking Running Group exercise (ex: Zumba, bootcamp, aerobics, etc.) Strength Training Treadmill Yoga based activity Other (please specify) Question Title * 4. Please provide information relative to your stress level: High- I often feel stressed and sometimes do not feel in control Moderate- I sometimes feel stressed but often feel in control Low- I rarely feel stressed and almost always feel in control Question Title * 5. Which of the following incentives would best motivate you to make healthier lifestyle choices and participate in our worksite wellness program? Prizes/Giveaways Money/Gift Cards Gym Membership Discount Employee/Department Recognition I don't need an incentive to participate Question Title * 6. Please indicate which resources and educational programs you would like to see offered in our worksite wellness program: Learning through webinars/seminars Healthy cooking demos Stress management and mental health Smoking and tobacco cessation support Physical activity Wellness challenges Weight loss support Nutrition information and education Diabetes Heart health/Stroke Cancer prevention Ergonomics/Back pain Walking programs Self-empowerment topics Clutter clearing Zumba Work/Life Balance/Goals/Planning Yoga Financial education Other (please specify) Done