Sample Wellness Program Survey
What reasons would motivate you to participate in a wellness program?
rewards/prizes
to improve my health
to interact with co-workers
something to do
Other  
What reasons would you give for not participating in a wellness program?
not enough time
not interested
the incentives are not appealing
not aware of the opportunities
Other  

Would you be more willing to participate in the wellness program as an individual or as a team?

individual
team
both
no preference

Which incentive would motivate you the most to participate or continue participating in the wellness program?

cash
gift cards
better health
wellness/health related promotional items (if so, list items in comment section)
Other  
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Educational Programs:

Please indicate how likely you would be to participate in each of the following programs if they were offered during the next year.

 Unlikely Somewhat Likely Likely Extremely Likely  
Back Safety  
Heart Disease Prevention  
Headache Prevention/Treatment  
Cholesterol Reduction  
Men's/Women's Health  

Employee Assistance Programs:

Please indicate how likely you would be to participate in each of the following programs if they were offered during the next year.

 Unlikely Somewhat Likely Likely Extremely Likely  
Financial Management  
Parenting Difficulties  
Managing Chronic Health Conditions  
Dealing with Stress/Anxiety  
Preparing a Will  

Nutrition Education Programs:

Please indicate how likely you would be to participate in each of the following programs if they were offered during the next year.

 Unlikely Somewhat Likely Likely Extremely Likely  
Healthy Cooking  
Healthy Eating  
Weight Management Programs  
Healthier Choices in Vending Machines  

Please indicate how likely you would be to participate in health promotion programs during the following times:

 Unlikely Somewhat Likely Likely Extremely Likely  
Before Work  
During Work  
After Work  
Weekend  

Other suggestions:

Please list any additional educational programs you would like us to consider.


 

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