OMB No. 0925-0642

Expiration Date 5/31/2020

 

Public reporting burden for this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0642).  Do not return the completed form to this address.

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* 1. Would you personally take part in a wellness program if we offered one?

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* 2. Would you participate in the wellness program on your own personal time? (e.g., before work, after work, or during lunch)

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* 3. If you answered yes to the previous question, when would be the best time for you to be involved in a wellness activity?

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* 4. What is the biggest barrier that would keep you from participating in a worksite wellness program?

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* 5. Which, if any, of the following programs/seminars would you take part in, if offered? Select all that apply.

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* 6. Which, if any, of the following screenings/clinics would you take part in, if offered? Select all that apply. 

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* 7. Which of the following physical activities would you take part in, if offered? Select all that apply. 

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* 8. What changes, if any, could be made to the work environment to better promote health and wellness? Please be specific. 

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