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* 1. First & Last Name

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* 2. Email Address

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* 3. Company Name

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* 4. Role and Department:

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* 5. Overall, our organization cares about its employees.

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* 6. Overall, our organization supports employee well-being.

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* 7. Managers in our organization actively support the well-being of their employees.

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* 8. People feel supported by their team in taking care of their well-being.

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* 9. Our organization creates opportunities for employees to connect with others for well-being support.

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* 10. Our organization is thoughtful about how and where work gets done – and understands the impact these decisions have on employee well-being.

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* 11. Our organization has communicated that employee well-being is important to our business success.

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* 12. Leaders in our organization encourage employees to prioritize their well-being.

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* 13. Our organization provides well-being tools and resources that show a commitment to supporting employee well-being.

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* 14. Our organization’s culture – underlying norms, values and beliefs – supports employee well-being.

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