Employee Wellness Interest Survey
Please take a few moments to complete this Employee Interest Survey so that we can plan
wellness programs that best meet your needs and interests.
Gender
Male Female
Age Group
21 – 30 31 – 40 41 – 50 51 – 60 Over 60
Would you participate in a wellness program?
Yes No
What is your fitness level?
Beginner (have not exercised in some time)
Intermediate (exercise whenever I can)
Active (regular exercise)
Other_______________________________________________________________________
What is the best time for you to participate in wellness activities?
Before work starts
After work ends
During my lunch break
Other_______________________________________________________________________
How often would you attend a workplace health & well-being activity?
Once a week
Once a month
Less than once a month
What would prevent you from participating in worksite wellness
activities?
Lack of time
Lack of interest
Lack of motivation
Mobility limitations
Other_______________________________________________________________________
______________________________________________________________________________
Which category fits you best?
I am not interested in pursuing a healthy lifestyle
I have been thinking about changing my health behavior
I am planning on making a health behavior change within the next 30 days
I have made some but need to make more health behavior changes
I already have a healthy lifestyle