Staff Wellness Survey Question Title * 1. Please indicate your level of interest in participating in workshops or receiving information on the following topic areas: Very interested Somewhat interested Not very interested Not at all interested Nutrition Nutrition Very interested Nutrition Somewhat interested Nutrition Not very interested Nutrition Not at all interested Weight loss Weight loss Very interested Weight loss Somewhat interested Weight loss Not very interested Weight loss Not at all interested Stress Management Stress Management Very interested Stress Management Somewhat interested Stress Management Not very interested Stress Management Not at all interested Tobacco Cessation Tobacco Cessation Very interested Tobacco Cessation Somewhat interested Tobacco Cessation Not very interested Tobacco Cessation Not at all interested Physical Activity (i.e. Walking, strength training, aerobics, pilates, fitness classes, yoga, etc) Physical Activity (i.e. Walking, strength training, aerobics, pilates, fitness classes, yoga, etc) Very interested Physical Activity (i.e. Walking, strength training, aerobics, pilates, fitness classes, yoga, etc) Somewhat interested Physical Activity (i.e. Walking, strength training, aerobics, pilates, fitness classes, yoga, etc) Not very interested Physical Activity (i.e. Walking, strength training, aerobics, pilates, fitness classes, yoga, etc) Not at all interested Specific disease topics (i.e. cancer, diabetes, blood pressure risk reduction) Specific disease topics (i.e. cancer, diabetes, blood pressure risk reduction) Very interested Specific disease topics (i.e. cancer, diabetes, blood pressure risk reduction) Somewhat interested Specific disease topics (i.e. cancer, diabetes, blood pressure risk reduction) Not very interested Specific disease topics (i.e. cancer, diabetes, blood pressure risk reduction) Not at all interested Other (please specify) Question Title * 2. Please rate the likelihood that you would participate in a stress management program related to each of the following topics if offered (1=Not at all likely, 5=very likely) 1 1.5 2 2.5 3 3.5 4 4.5 5 Mindfuness/meditation training Mindfuness/meditation training 1 Mindfuness/meditation training 1.5 Mindfuness/meditation training 2 Mindfuness/meditation training 2.5 Mindfuness/meditation training 3 Mindfuness/meditation training 3.5 Mindfuness/meditation training 4 Mindfuness/meditation training 4.5 Mindfuness/meditation training 5 At your desk stretches At your desk stretches 1 At your desk stretches 1.5 At your desk stretches 2 At your desk stretches 2.5 At your desk stretches 3 At your desk stretches 3.5 At your desk stretches 4 At your desk stretches 4.5 At your desk stretches 5 Yoga Yoga 1 Yoga 1.5 Yoga 2 Yoga 2.5 Yoga 3 Yoga 3.5 Yoga 4 Yoga 4.5 Yoga 5 Question Title * 3. Would you personally participate in a smoking cessation program if we offered one? Yes No I don't know Question Title * 4. Would you be willing to participate in staff wellness during your own personal time? Yes No Not sure Question Title * 5. What would be the best time of day for you? 6:00-9:30AM 11:30AM-2:30PM 5-7PM 7-9PM Question Title * 6. Which of the following ways would you like to receive health information? Internet Based information Worksite Based Programs Newsletter Personal Counseling Printed Material Support Group Community Based Programs None of the Above Other (please specify) Question Title * 7. What school(s) do you work in? Question Title * 8. What is your role? Teacher Para Professional Nurse Administration Other (please specify) Question Title * 9. What is your gender? Male Female Question Title * 10. Which category below includes your age? 18-24 25-29 30-34 35-39 40-44 45-49 50-54 55 or older Done