Please fill out the survey below.

What type of organization do you work for? Corporation Fitness Center Hospital/Health System University Association Other

How long has your company had a worksite wellness program? Don't have one Less than 1 year 1-3 years 4-5 years 5-7 years 8-10 years More than 10 years

What percentage of your job responsibilities is devoted to management of your company's wellness program?
None
1%-25%
26%-50%
51%-75%
76%-99%
100%

How many employees are employed by your organization? Less than 10 10-49 50-99 100-499 500-999 1,000+

How many employees comprise your wellness department?

What percentage of your employees participate in your wellness program?

How much does your organization budget for wellness and health promotion programs? Nothing Less than $10,000 $10,000 to $24,999 $25,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 $100,000+

What services are included in your wellness program? (Check all that apply.)

Nutrition
Weight-control
Health Club subsidy
On-site fitness center
Health screenings
High blood pressure
Smoking-cessation
Health risk assessments
Stress management
Prenatal care
Disease management
Health fairs
Health education classes
EAPs
Mind-body programs
Massage therapy
Other

If you offer "other" programs, please list them here.

Who is eligible to participate? (Check all that apply.)

Employees
Retirees
Family members

Have you seen any of the following improvements in employees participating in your program? (Check all that apply.)

Improved morale
Less absenteeism
Increased productivity
Improved health
Other

If you've seen other improvements than the ones cited above, please list them here.

What has been the effect of your wellness program on your organization's healthcare costs? Decreased costs Costs remained the same Increased costs Too soon to tell Don't know

If your costs have decreased, by what percentage have they decreased? Not applicable Less than 1% 1%-5% 6%-10% 11%-15% 16%-20% 21%-25% 26%-30% More than 30% Don't know

If your costs have increased, by what percentage have they increased? Not applicable Less than 1% 1%-5% 6%-10% 11%-15% 16%-20% 21%-25% 26%-30% More than 30% Don't know

Which of the services in your wellness program has had the greatest impact on your organization's healthcare costs?

Nutrition
Weight-control
Health Club subsidy
On-site fitness center
Health screenings
High blood pressure
Smoking-cessation
Health risk assessments
Stress management
Prenatal care
Disease management
Health fairs
Health education classes
EAPs
Mind-body programs
Massage therapy
Other

If you selected "other" for the previous question, please cite the program here.

Do you evaluate the results of your wellness program?
Yes
No
Not yet, but have plans to
No, and no plans to evaluate it

What seems to be the biggest obstacle in initiating or operating a wellness program?

Finding funding
Proving program worth/measuring effectiveness
Senior management support
Lack of time
Lack of staff
Employee motivation/participation
Raising awareness of program
Other

If you selected "other" for the previous question, please cite the obstacle here.

What publications or information services (wire, Internet, etc.) do you depend on for your wellness program management needs?

Are you happy with those resources?
Yes
No

Do you belong to any of the following industry associations?

Association for Worksite Health Promotion (AWHP)
National Wellness Association (NWA)
American Association of Occupational Health Nurses (AAOHN)
Other

Please list the other associations to which you belong.

Additional comments:

Yes, I'm interested in receiving the free executive summary. Please contact me when it is ready for release.

Contact Information:
Name
Title
Company
Street Address
City
State
Zipcode
Phone Number
Fax Number
E-Mail	Remember: ALL contact information will be kept strictly confidential and will not appear in any of the survey's results.

Note: The FREE Executive Summary will only be sent to individuals who completely fill out the survey AND provide their e-mail address above.