MARSH & McLENNAN AGENCY

HEALTH MANAGEMENT

NEEDS AND INTERESTS SURVEY


Dear CLIENT:

CLIENTwants to encourage our employees to lead a healthy lifestyle. Because the idea of employee wellness means different things to different people, this survey is your chance to help us identify which health management activities are most important and are of interest to our employees as we look to outline a formal program. This is your opportunity to get involved as well. Be sure to let us know at the end of the survey if you are interested in getting helping out, and/or becoming a “Wellness Champion” for your location.

Please take a few moments to complete this survey. All answers are anonymous and confidential.

What is a Health Management Program?

Simply put, it is a program designed to help employees stay well. CLIENTwould like to provide the tools and resources to allow our employees to lead a healthier life.

A Few Questions About You

1) Would you personally take part in a health management program if we offered one?

 Yes  No  Don’t know/Not sure

2) Are you currently covered under the CLIENThealth insurance plan?

 Yes  No

3. How would you rate your health in the last 12 months?

 Excellent

 Very good

 Good

 Fair

 Poor

 Prefer not to say

4) Do you have any health or fitness goals that you are trying to reach right now?

 Yes  No

4a) If yes, which of the following describes your health or fitness goals? (select all that apply)

 Lose weight

 Get more exercise

 Eat more healthy foods

 Reach a fitness goal (such as running a 10K race)

 Have better work/life balance

 Improve a health problem I have now/Prevent future health problems

 Other (Please specify) ______

5) Which of the following statements best describe your typical level of physical activity?: (physical activity being 30 minutes of focused exercise through walking, running, fitness class, sports, etc):

 I haven’t exercised for 30 minutes in the past year

 I exercise when I can, typically a few times per month

 I am able to find time to exercise about 1-2 times per week

 I make time on a regular basis, about 3 or 4 times per week

 I’m out there almost every day, usually 5-7 times per week

6) The reason I don’t exercise more is: (select all that apply)

 I don’t like to exercise

 Too busy with work life

 Too busy with home life

 I don’t belong to a gym

 My spouse/partner is inactive

 I’m not an athlete – I don’t see the benefits of why I should

 Other (Please specify) ______

7) Which of the following statements best describe your typical nutritional habits?

 I eat what I want and don’t pay attention to food labels, fat & sugar content or calorie intake

 I know I eat too much of the ‘bad food’ and not enough ‘good food’

 For the most part I eat healthy, but splurge on at least one meal/snack each day

 I try to only eat whole foods, lean meats and reach the 5-7 servings of fruits & vegetables daily

8) Do you smoke?

 Yes

 No

8a) If Yes, are you interested in quitting this year?

 Yes

 No

 Maybe

Program Interests

We would like your input on possible health management program initiatives that are being considered. Please rate your interest in the following programs/seminars if offered:

Educational Programs/Seminars / Very High / High / Neutral / Low / Very Low
Exercise/Physical Fitness Programs
Stress Management
Heart disease prevention
Nutrition
Weight Management
Healthy Back
Substance abuse
Women’s Health Issues
Men’s Health Issues
Stop Smoking Programs
Cancer Risk Reduction
Managing chronic health conditions (diabetes, hypertension, etc.)
Balancing Work/Life and Family

Program Screenings

Please rate your interest in the following screenings if offered:

Program Screenings / Very High / High / Neutral / Low / Very Low
Blood Pressure
Cholesterol
Diabetes
Body Fat Analysis
Flu Shots
Nutritional Counseling

Fitness Programs

Please rate the likelihood that you would take part in the following physical activities if offered:

Fitness Programs / Very High / High / Neutral / Low / Very Low
Walking Clubs
Running Clubs
Yoga
Stretching programs
Strength Training
Worksite recreation teams (softball, basketball, volleyball)

Events

Please rate the likelihood that you would take part in the following events if offered:

Even Events / Very High / High / Neutral / Low / Very Low
Individual Competitions
Team Challenges
Sports Tournament
Other (Please be specific)

Motivators

Please rate the chance that each of the following would motivate you to participate in a health management program:

Motivators / Very High / High / Neutral / Low / Very Low
Lifestyle Change
Personal Recognition
Competition
Social Opportunities
Educational
Incentives (Money, Rewards)
Improved Well-Being
Family
Other (Please be specific)

Times

Please indicate how likely you would be to participate in a health management program during the following times:

Times / Very High / High / Neutral / Low / Very Low
Before work
During lunch at work
After work
Weekends

Any Other Interest or Suggestions (please specify)

List any suggestions you may have for health management programs. Your input is an important element to the success of our program.

______

______

______

Are you interested in getting involved with the Health Management/Wellness Team?

If Yes, please list your name, email and phone number so we can be sure to reach out to you!

______

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