WWKS - Physical Activity Assessment

Physical Activity/Sedentary Behavior Assessment

In developing a comprehensive worksite wellness initiative to address physical activity, five strategies need to be employed: information, program, benefit design, policy, and environment.
Your worksite's individual responses to the survey will not be shared with anyone not affiliated with WorkWell KS. This survey will be used as an assessment to provide worksites with information about the steps your worksite can take to establish a worksite wellness initiative. Only aggregated results (with no worksite identifiers) may be published. If you have any questions regarding this survey, please contact Dr. Elizabeth Ablah at 316-293-2627 (eablah@kumc.edu).
Name of worksite*
Primary contact at worksite*
Contact email*
example@example.com
County*
Zip*
City*
Phone Number*
Please enter a valid phone number.
Approximate number of employees
Not counting temporary or seasonal
Approximate number of employee dependents
Spouses and children
What industry type best describes your worksite?

Agriculture, Forestry, Fishing, and HuntingMining, Quarrying and Oil and Gas ExtractionUtilitiesConstructionManufacturingMachinery, Equipment, and Supplies Merchant WholesalersRetail TradeTransportation and WarehousingInformationFinance and InsuranceReal Estate, Rental, and LeasingProfessional, Scientific, and Technical ServicesEducational ServicesHealthcare and Social AssistanceArts, Entertainment, and RecreationAccommodation and Food ServicesGrant Making and Civic OrganizationsPublic Administration (including health departments)Other
Physical Activity Information
Does your worksite provide employees information (e.g., brochures, videos, posters, pamphlets, newsletters) addressing the benefits of physical activity or being less sedentary?*

YesNo
Does your worksite promote information (e.g., fliers, poster, email) about worksite activities (e.g. exercise classes) and/or local opportunities to be physically active or less sedentary?*

YesNo
Has your worksite conducted a sustained, focused media and education campaign to promote physical activity?*

YesNo
Does your workplace have a parking lot?*

YesNo
Does your worksite promote parking farther away to encourage more physical activity?*

YesNo
1:Calc:Value Scale Total
1:Calc:Score
1:Calc Percent
Physical Activity Program
Does your worksite offer or refer employees to a program that counsels employees about how to be physically active?*

YesNo
Does your worksite offer regular physically active team challenges or competitions?*

YesNo
Does your worksite offer an employee activity club (e.g. walking club) or team?*

YesNo
Does your worksite offer regular exercise programs or classes?*

YesNo
Does your worksite offer at least one organized 15 minute physical activity break each work day?*

YesNo
Does your worksite offer a "nudge" (e.g., e-mail, text, music) prompting employees to move?*

YesNo
Does your worksite offer a program for employees to reduce the amount of time they sit or are sedentary at work?*

YesNo
Does your worksite provide an established time during work hours for employees to participate in an organized physical activity (e.g., weights, walking, group stretching).*

YesNo
2:Value Scale - total
2:Calc:Score
2:Calc Percent
Physical Activity Benefit Design
Does your worksite have a corporate agreement with a health club or gym to offer employees discounted or subsidized memberships?*

YesNo
Does your community offer public transportation?*

YesNo
Does your worksite incentivize use of public transportation?*

YesNo
Does your basic benefit package for employees include a benefit (e.g., premium reduction, deposit in HSA) for maintaining or reaching a certain level of physical activity?*

YesNo
Does your worksite provide wearable activity trackers (excluding pedometers) for employees (e.g., fitbit, garmin, or other sustainable physical activity trackers)?*

YesNo
3:Calc:Value Scale Total
3:Calc:Score
3:Calc Percent
Physical Activity Policy
Does your worksite have a written policy that allows for walking meetings?*

YesNo
Does your worksite have a written policy providing flexible work arrangements (flex-time) for employees?*

YesNo
Are all employees performing manual labor at the worksite?*

YesNo
Does your worksite have a written policy that allows employees to be physically active while 'on the clock', offering at least a cumulative 30 minutes of each work day (i.e. two 15 minute periods) to exercise?*

YesNo
Does your worksite have a written policy for mandatory stretch breaks?*

YesNo
Does your worksite have a written policy that allows people to stand, stretch, and/or move during meetings, at least every 30 minutes?*

YesNo
4:CalcValue Scale Total
4:Calc:Score
4:Calc Percent
Physical Activity Environment
Does your workplace have stairs?*

YesNo
Does your workplace have an elevator?*

YesNo

Does your workplace provide?*

	Yes	No
A safe outdoor activity feature (green space, maintained walking trail)
Secure bicycle rack or bike storage

Does your worksite increase parking lot fees (e.g. making closer parking more expensive) or restrict parking to encourage physical activity or active transportation?*

YesNo

Does your worksite promote use of the stairs with paintings, bright colors, motivational signs, fruit, temperature control, or music in the stairwell?*

YesNo

Inside the building, does your worksite offer (select all that apply):*

	Yes	No
Toilets adjacent to central areas
Standing options in meeting rooms and/or common areas (standing height tables)
Light, attractive walkways
A neighborhood-style layout (with shared services and amenities in the center of the office suite)
Posted maps or signs of walking routes inside the building
Posted maps or signs of walking routes outside the building
Shower(s)
Changing facility/lockers for clothes
Fitness facility on site with exercise equipment (treadmill, weights)
Fitness center with updated and useful equipment
Indoor facilities that employees can use for physical activity, such as a room for yoga classes or table tennis (not a fitness facility)

Does your worksite have skip-stop elevators (e.g. elevator stops only at every third floor)?*

YesNo

For desk-based employees, does your worksite provide:*

	For each desk-based employee	For some desk-based employees or those who have a medical need	As a shared resource (one desk with multiple users)	None
Standing desks
Treadmill desks
Cycling desks

Does your worksite provide equipment, such as headsets or speaker phones, to facilitate sitting less?*

YesNo
Is there a positive social climate that encourages physical activity in your workplace?*

YesNo

In your workplace:*

	Yes	No
Most executives seek ways to improve the work climate to increase physical activity or reduce sedentary behavior
Most executives are supportive of employees being less sedentary and more active
Most managers seek ways to improve the work climate to increase physical activity or reduce sedentary behavior
Most managers are supportive of employees being less sedentary and more active
Most managers encourage employees to participate in physical activity or sedentary reduction programs

5:Calc Value Scale - Total
5:Calc:Score
5:Calc Percent
Should be Empty:

	Yes	No
Easily accessible
Attractive

Physical Activity/Sedentary Behavior Assessment

Physical Activity Information

Physical Activity Program

Physical Activity Benefit Design

Physical Activity Policy

Physical Activity Environment