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* 1. Please provide your email address

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* 2. Please provide the name of your organization

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* 3. Select the ongoing wellness service offerings you currently offer (select all that apply):

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* 4. Wellness offerings are available to (select one that applies best):

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* 5. My organization has policies that promote wellness, including (select all that apply):

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* 6. Wellness outcomes are presented at least annually to upper management.

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* 7. Upper management plays a roll in wellness communications to employees.

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* 8. At least one individual is designated as the Wellness leader within the organization and has some control over wellness decision making and communication

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* 9. Wellness program details are available for employees to access at anytime on a central employee resource (health portal, Intranet, HR/Wellness designee, printed materials)

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* 10. Proactive wellness communications are pushed to employees (select one most applicable option).

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* 11. Average annual participation in biometric health screening among eligible employees is: (select one most applicable option):

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* 12. Average participation in online or live workshops (if applicable) is: (select one most applicable option):

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* 13. Average participation in health coaching among designated high risk eligibles is: (select one most applicable option):

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* 14. Wellness program performance success is based on (select all that apply):

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* 15. Select the one response most appropriate to your organization's use of cost sharing (outcomes based incentives):

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