Employee Wellness Activity Tracker Form
Log your participation in wellness activities to support a healthy and active workplace using the Employee Wellness Activity Tracker Form.
Employee Full Name
*
First Name
Last Name
Department
*
Please Select
Human Resources
Engineering
Sales
Marketing
Finance
Operations
Other
Work Email Address
*
example@example.com
Date of Activity
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Wellness Activity
*
Please Select
Walking/Running
Yoga/Meditation
Gym/Strength Training
Cycling
Team Sport
Wellness Workshop
Other
Duration (in minutes)
*
Frequency of Participation
*
Please Select
Daily
Several times a week
Weekly
Monthly
First time
Personal Wellness Goal for This Activity
Preferred Time of Day for Wellness Activities
Please Select
Morning
Afternoon
Evening
No Preference
Additional Comments or Follow-Up Notes
Submit Activity
Should be Empty: