Corporate Wellness Health Assessment Form
Please complete this assessment to help us understand your general wellness, lifestyle habits, and work-related health considerations.
How would you rate your overall health and wellness?
*
1
2
3
4
5
How many days per week do you engage in at least 30 minutes of physical activity?
*
Please Select
0 days
1-2 days
3-4 days
5-7 days
How would you describe your typical eating habits?
*
Mostly healthy and balanced
Somewhat healthy with occasional indulgence
Irregular or unbalanced
On average, how many hours of sleep do you get per night?
*
Please Select
Less than 5 hours
5-6 hours
7-8 hours
More than 8 hours
How often do you feel stressed at work?
*
Rarely
Sometimes
Often
Almost always
Please rate the following aspects of your work environment.
*
Rows
Excellent
Good
Fair
Poor
Physical comfort (lighting, seating, etc.)
1
2
3
4
Access to healthy resources (food, water, breaks)
5
6
7
8
Support from colleagues
9
10
11
12
Support from management
13
14
15
16
How would you rate your work-life balance?
*
Very poor
1
2
3
4
Excellent
5
1 is Very poor, 5 is Excellent
Do you participate in any wellness activities provided by the company?
*
Yes, regularly
Occasionally
No
What motivates you to maintain your health and wellness? (Select all that apply)
*
Personal well-being
Family
Work performance
Company incentives
Other
Please share any additional comments or suggestions regarding your health and wellness at work.
Submit Assessment
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