Wellness Needs Assessment

The SPU Institutional Review Board has reviewed and approved this survey for quality assurance purposes.
1. Tell Us About Yourself

I am a:
2. I am generally (select all that apply):
MondayTuesdayWednesdayThursdayFridayWeekend
ON-SITE: Before 8a.m.
ON-SITE: 8a.m. – 9a.m.
ON-SITE: 9a.m. – 10a.m.
ON-SITE: 10a.m. – 11a.m.
ON-SITE: 11a.m. – 12noon
ON-SITE: 12noon – 1p.m.
ON-SITE: 1p.m. – 2p.m.
ON-SITE: 2p.m. – 3p.m.
ON-SITE: 3p.m. – 4p.m.
ON-SITE: 4p.m. – 5p.m.
ON-SITE: After 5p.m.
OFF-SITE / TELECOMMUTING:
3. I am:
4. I am:
5. How do you usually receive health information or education? (select top 2)
6. Of areas noted below, which do you think are most effective for receiving health information/education? (select top 2)
7. If you receive SPU health benefits, did you know that you can earn $75 by completing the WebMD Health Quotient Personal Health Assessment between April 1 and April 30?
8. Please indicate how you were notified (select all that apply):
9. What topics are of most interest to you (select 5 or fewer):
10. Any other topics of interest?
11. How likely are you to attend or participate in the following programs:
ExtremelyLikelySomewhatUnlikely
On-site education seminars and/or discussions about the items you specified above
Contact the Employee Assistance Program (EAP) for a variety of issues: child and elder care, alcohol and drug abuse, difficulties in relationships, stress and anxiety with work or family, depression, personal achievement, life improvement, emotional well-being, financial and legal concerns, and grief and loss, education, adoption, pet care, daily living and travel, and dependent care.
Asking another employee to attend or participate in a health/wellness activity or event with you (whether on-site or not)
Asking your spouse and/or children to attend or participate in a health/wellness activity or event with you (whether on-site or not).
Book study on health and diet topic
Read a periodic Wellness newsletter (includes those sent via e-mail or hardcopy)
On-line self-directed health study
Webinar / Audio Conference / Other media
Listen to or Watch iTunesU recorded events
Regular physical activity group on-site
Participate in a group challenge (i.e. the most number of logged steps, lost weight, etc.)
Sign up to review your personal health benefits (medical, dental, vision and flexible spending accounts) –includes both individualized attention and group settings
12. Are you willing to be contacted about possible participation in the SPU Wellness Committee?
13. Are you willing to be contacted to help the Wellness Committee?
14. Would you be willing to prepare a subject of interest for SPU employees?
15. If you could name SPU’s Wellness Program, what would it be?
16. Additional comments/suggestions/feedback:
17. OPTIONAL: if you answered “Yes” to #12, #13 or #14, please complete:
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