Employee Wellness Survey

The Health Promotion Services Department is seeking your input regarding the development of a worksite wellness program. We are initially focusing on two areas of wellness: physical activity and tobacco cessation. Please take a few moments to answer the following questions. If a question doesn't apply to you, simply skip it. Thank you for your honest opinions.
Name (optional): 


  1. Do you currently engage in the recommended 20-30 minutes of moderate to vigorous physical activity on most days of the week?
    Always
    Sometimes
    Never


  1. What types of physical activities or promotions would you like to see take place at L.A. Care? (Check all that apply).
    Walking Club
    Fitness Challenge Program
    Stair Climbing Groups
    Step Aerobics Class
    High Impact Aerobics Class
    Low Impact Aerobics Class
    Strength Training/Stretching


  1. What would you like to know about physical activity? (Check all that apply).
    Health problems that may be caused by inactivity
    Benefits of physical activity
    Tips to start and maintain physical activity
    Tips to get my child/children physically active
    How to perform a variety of physical activity skills
    How to set personal goals and self-monitor progress
    Increase awareness of physical activity programs


  1. Do you currently smoke (or use other forms of tobacco)? If no, skip to question #9.
    Yes
    No


  1. Are you planning to quit?
    Yes
    No


  1. When would you like to quit?
    I'm ready now
    In the next 6 months
    Within the next year


  1. Would you be interested in participating in a "Stop Smoking" program offered through L.A. Care?
    Yes
    No


  1. What type of program would you prefer?
    Group class
    Telephonic
    Internet


  1. How would you like to be notified about employee wellness activities/programs and news or tips about healthy lifestyle choices? (Check all that apply).
    Dedicated bulletin board
    Monthly email tips
    Flyer distributed with paychecks
    Intranet
    Discussion at staff meetings


  1. May we contact you in the future regarding your participation in an employee wellness program? If yes, please include your name at the top of the survey.
    Yes
    No


  1. Additional comments?





Mark Strunin