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* 1. In which county is your organization located?

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* 2. How many employees does your organization have?

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* 3. Which industry best describes your organization?

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* 4. How would you classify your organization? (Check all that apply)

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* 5. Does your organization have a specific individual or group of individuals responsible for any of the following? (Check all that apply)

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* 6. If your organization currently offers wellness programming (e.g. any formalized wellness/health initiatives), how long has it been in place?

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* 7. How does your organization support a culture of employee health and wellness?

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* 8. What resources does or would your organization devote to worksite wellness programs? (Check all that apply)

  Currently offer Would like to offer
Time for employees to participate at work
Staff for administering activities
Money for health and wellness services
Financial incentives to employees
Prizes or rewards (e.g gift cards, FitBits, etc.)
Flex-Time (e.g. seasonal work shifts, lunch breaks, rolling holidays)
Health insurance premium discounts
Healthy food options
Email, flyers, announcements, newsletters
Professional level discounts on goods and products (e.g. pro-deals, 30% off gear, tools or equipment)?

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* 9. What benefits do you attribute to worksite wellness? (Check all that apply).

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* 10. What types of programs would your employees most benefit from? (Check all the apply)

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* 11. What challenges do you face when trying to implement a wellness program? (Check all that apply)

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* 12. What external support would benefit your organization in promoting health, wellness and safety? (check all that apply)

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* 13. Do your employees ever work in the following capacities? (Check all that apply)

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* 14. What structured elements does your organization have to address workplace safety and hazards? (Check all that apply)

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* 15. Does your organization provide new employee training? If yes, which training items are addressed? (Check all that apply)

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* 16. How are your employees unique compared to other occupations, regions or environments? Please provide rough percentage estimates of your employees who;

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* 17. Are there any other comments or ideas that you would like to share about workplace health and safety? (Please respond in 400 characters or less)

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