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Monday, 06 September 2010

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Monday, 01 March 2010 19:23

Survey

First name

Last name

eMail address

Telephone

Job title

Company name

Company URL

Address

Address 2

City

Province

Postal code

Number of employees

Number of locations
Enter '0' if not applicable

Your goals for a wellness program
Check all that apply

Reduce Insurance Costs Attract / Retain Employees Reduce Absenteeism Increase Productivity Premium Differential (Those who participate versus those who don't) Premium Differential (Based on health status) Have a proactive (versus reactive) benefit plan design

Interests
Check all that apply

Onsite Health Screenings Employee Training / Education Programs Health Risk Assessment Health Coaching / Health Management Behavior Modification (smoking cessation, stress management, weight loss, etc.) Employee Assistance Programs Disease Management Programs Incentive Programs Fitness Centre Management Team Building Events Health/Wellness Days Full-time / Part-time Onsite Health Promotion Expert Fitness Challenges Internet tools and other online wellness programs Flu Shots Points based tracking of participation

When do you plan to implement a wellness program?

1-3 Months 3-6 Months 6-12 months No firm date set

What is your benefit renewal date?
Click the button for a popup calendar

What is your company’s estimated annual budget Per Employee Per Month (PEPM) for wellness programs?.

No employer investment R10 PEPM R11 – R20 PEPM R21 - R30 PEPM R31 – R40 PEPM R41 – R50 PEPM R51 – R60 PEPM R61 - R70 PEPM R71 – R80 PEPM R81+ PEPM

Are you responsible for deciding how and when to pursue a Wellness Program?

Yes, solely Yes, as part of a group No

If 'No' (above), who is?

Please attach any supporting documents in the fields below

Attachment 1

Attachment 2

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