2019 Wellness by Design Worksite Award Application

1. Thanks for applying for Wellness by Design recognition!

Hennepin County appreciates your organization’s strong commitment to creating a healthy workplace. Hennepin County will be a better place to live, learn, work, and play when more worksites are Wellness by Design winners.

The 2019 Wellness by Design awards will be presented to worksites for health promotion efforts occurring in 2017–2018. Please answer the questions based on this time frame.

If you are unable to complete the application in one session, you may exit and return to your application later from the same computer. All completed screens will be saved. (Note that a page is considered complete and saved only when you click to the next section.)

If you have questions, please contact Linda Brandt at E-mail link. Please submit the final version of your application by Friday, March 22, 2019.

Question Title

1. Please provide the following information. Correct spelling is important since this information will be used at the celebration event and on the Hennepin County Web site. Please note that worksites must have at least 20 employees to apply for recognition.

Contact Person: *

Job Title: *

Organization: *

Address: *

City: *

ZIP:

Number of Employees: *

Industry: *

E-mail: *

Phone: *

Question Title

2. To foster management support, please provide the contact information of someone in your organization's senior management who is an existing or potential champion of worksite health. This information will be used to invite this person to the recognition breakfast if your organization is given an award.

Name:

E-mail: