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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
Attachment 3
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