Kp Run/Walk

2012 Kaiser Permanente Corporate Cup Survey "Most Fit Company"
RequiredRequired Question(s)
Required 1.
Please enter the information indicated below.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Please answer the following four questions on your company's characteristics.
 
2.
To which industrial sector does your company belong?
 

50 characters left.
3.
How many worksites does your company have in Georgia?
 

50 characters left.
4.
How many full time employees are at this location?
 

50 characters left.
5.
How many part time employees are at this location?
 

50 characters left.
Please answer the following questions on your wellness program overview.
 
6.
Our company has an officially organized Worksite Wellness or Health Promotion Program open to all full-time employees.
Yes
No
  • Comment:

  • 500 characters left.
7.
Our company has a health or safety committee or other group that has worksite wellness as a part of it's scope of work.
Yes
No
  • Comment:

  • 500 characters left.
8.
Our company assesses employees' health status or knowledge, attitudes, skills, and/or habits related to health behaviors and wellness (health risk accessments, wellness survey, etc).
Yes
No
9.
Our company tracks employees participation in company-sponsored worksite wellness or health promotion programs and activities.
Yes
No
  • Comment:

  • 500 characters left.
10.
Our company measures participant changes in behavior, health or fitness status to verify effectiveness of the programs.
Yes
No
  • Comment:

  • 500 characters left.
11.
Our company organizes events or programs based on a health observance (such as American Heart Month, Diabetes Alert Day, Great American SmokeOut, etc.).
Yes
No
  • Comment:

  • 500 characters left.
12.
Please include a description of your company's wellness program.
 

500 characters left.
Please answer the following questions on physical activity at your company.
 
13.
Our company has walking trails, bicycle racks or provides any other accommodations (i.e. showers, changing rooms) to support physical activity at work during break times or in commuting to work.
Yes
No
  • Comment:

  • 500 characters left.
14.
Our company has an on-site exercise/fitness facility available to employees, and/or subsidizes employees' membership in health clubs/gyms in the community.
Yes
No
  • Comment:

  • 500 characters left.
15.
Our company allows employees to use the on-site exercise/fitness facilities, participate in on-site fitness classes, or be physically active during the work day.
Yes
No
  • Comment:

  • 500 characters left.
16.
Our company participates in or sponsors a corporate fitness challenge, physical activity event, and/or sports team for employees.
Yes
No
  • Comment:

  • 500 characters left.
17.
Our company provides educational programs on any specific chronic disease such as cancer, diabetes, or heart disease.
Yes
No
  • Comment:

  • 500 characters left.
18.
Our company distributes information to workers in company newsletters, e-mails or other mailings about the importance of being physically active.
Yes
No
  • Comment:

  • 500 characters left.
Please answer the following questions on health promotion offerings/support at your company.
 
19.
Our company has healthy food options available in the cafeteria and/or vending machines (such as low-fat, low-sodium snacks).
Yes
No
  • Comment:

  • 500 characters left.
20.
Our company prohibits smoking and eliminates exposure to second-hand smoke.
Yes
No
  • Comment:

  • 500 characters left.
21.
Our company posts "cues to actions" or signage to promote healthy behaviors, such as walking/taking stairs, choosing fruit as a snack, or maintaining the company's smoke-free policy.
Yes
No
  • Comment:

  • 500 characters left.
22.
Our company offers training to employees on cardiopulmonary resuscitation (CPR) and/or first aid.
Yes
No
  • Comment:

  • 500 characters left.
23.

Our company has at least one automated external defibrillator (AED) present at your company's primary worksite in a prominent and well-marked location.
Yes
No
  • Comment:

  • 500 characters left.
24.

Our company's health benefits package includes preventive clinical services.
Yes
No
25.
Our company offers screenings and disease management services (blood pressure check, blood sugar check, cholesterol check, medication checks, etc.)?
Yes
No
  • Comment:

  • 500 characters left.
26.


Our company's leadership is visibly supportive of worksite wellness initiatives.
Yes
No
  • Comment:

  • 500 characters left.
27.

Our company has included worksite wellness programs as part of the budget.
yes
no
  • Comment:

  • 500 characters left.
28.

Our company's worksite wellness or health promotion program is branded and can be easily identified by participants/employees.
yes
no
  • Comment:

  • 500 characters left.
29.

Our company's wellness program was implemented based on a multi-year strategy.
yes
no
  • Comment:

  • 500 characters left.
30.

Our company's worksite wellnes programs offer tips and tools for including dependents (non-employees) in related activities.
yes
no
  • Comment:

  • 500 characters left.
31.

Incentives
Our company offers a mixture of incentives including cash, tokens, premium discounts, etc. for program participation.
Our company offers cash incentives only (What is the annual total possible cash value $______)
Our company offers premium discounts only.
Our company offers the incentive of eligibility for a richer plan design based on program participation.
Our company offers incentives for improvement in biometric measures such as blood pressure, BMI and/or triglyceride levels (not only participation based incentives).
32.
And finally... What makes your company "The Most Fit Company"?
 

500 characters left.