Workplace Wellness Assessment Checklist
Posted September 14, 2016
| # | Wellness Component | Yes | In Process | No | Potential Priority | Comments |
| General | ||||||
| 1 | Do you have support from key stakeholders such as senior leadership, HR managers, safety officers, etc.? | |||||
| 2 | Do you currently have a policy outlining the requirements and functions of a comprehensive workplace wellness program? | |||||
| 3 | Do you have a committee that meets at least once a month to oversee your workplace wellness program? | |||||
| 4 | Do you have a workplace wellness plan in place that addresses the purpose, nature, duration, resources required and expected results of your program? | |||||
| # | Wellness Component | Yes | In Process | No | Potential Priority | Comments |
| 5 | Does your new employee orientation include an explanation of workplace wellness programs, and are new hires given copies of any physical activity, nutrition and tobacco use policies? | |||||
| 6 | Does the worksite offer educational programs for health areas such as physical activity, nutrition and tobacco cessation? | |||||
| 7
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Do you encourage employee participation in wellness programs? The following are ways to promote participation:
· Information at orientation · Flyers or bulletin boards · Letters mailed to employees · Announcements at meetings · Employee newsletter articles · Incentive or reward programs · Public recognition · Health insurance discounts · Sponsor employee sports teams |
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| 8 | Do you provide health counseling or other support mechanisms to modify behaviors? | |||||
| 9 | Do you offer adequate health care coverage for employees and their families for the prevention of and management of chronic disease? | |||||
| 10 | Is there a budget for employee health promotion that includes funds for programs or a portion of a salary for a coordinator? | |||||
| General areas totals (number of “yes,” “in process” and “no” items) | ||||||
| # | Wellness Component | Yes | In Process | No | Potential Priority | Comments |
| Physical Activity | ||||||
| 11 | Does your company culture discourage sedentary behavior, such as watching TV on breaks and sitting for long periods of time? | |||||
| 12 | Do you provide flexible scheduling so employees can make time for exercise? | |||||
| 13 | Are employees provided with breaks during working hours and encouraged to be active during those breaks? | |||||
| 14 | Does the company map out on-site or nearby walking trails? | |||||
| 15 | Does the company encourage employees to map their own biking or walking routes to and from work? | |||||
| 16 | Does the company allow for walk-and-talk meetings instead of sit-down meetings to encourage activity? | |||||
| 17 | Do you provide exercise messages and information to employees? | |||||
| 18 | Do you provide prompts to promote physical activity near stairwells or elevators? | |||||
| 19 | Do you provide bike racks in safe and convenient locations? | |||||
| 20 | Do you provide showers or changing facilities? | |||||
| # | Wellness Component | Yes | In Process | No | Potential Priority | Comments |
| 21 | Do you provide outdoor exercise areas, playing fields or walking trails for employee use? | |||||
| 22 | Do you provide or support a broad range of competitive and non-competitive physical activities that help develop the skills needed to participate in physical activities? | |||||
| 23 | Do you offer company-sponsored fitness programs or clubs for employees other than at an exercise facility? | |||||
| 24 | Do you provide free, discounted or employer subsidized memberships to fitness centers? | |||||
| 25 | Do you offer incentive-based programs to encourage activity (e.g., pedometer walking campaigns)? | |||||
| 26 | Do you provide on-site physical activity classes such as aerobics, kickboxing, yoga, etc.? | |||||
| 27 | Do you provide an on-site exercise facility? | |||||
| 28 | Do you provide incentives for engaging in physical activity (e.g., merchandise, coupons or cash)? | |||||
| 29 | Can employees use the worksite’s indoor or outdoor physical activity facilities outside of work hours? | |||||
| 30 | Do you provide on-site childcare coverage to facilitate physical activity participation? | |||||
| Activity area totals (number of “yes,” “in process” and “no” items) | ||||||
| # | Wellness Component | Yes | In Process | No | Potential Priority | Comments |
| Nutrition | ||||||
| 31 | Do you send healthy eating messages to employees (via email, messages, bulletin boards, etc.)? | |||||
| 32 | Do you promote the consumption of fruits and vegetables in catering and cafeteria policies through motivational signs, posters, etc.? | |||||
| 33 | Do you provide protected time and dedicated space away from the work area for breaks and lunch? | |||||
| 34 | Do you offer appealing, low-cost, healthy food options, such as fruits and vegetables in the vending machines, snack bars and break rooms? | |||||
| 35 | Do you promote healthy choices by increasing the number of healthy options that are available? Do you use competitive pricing to make healthy choices more economical? | |||||
| 36 | Does your on-site cafeteria follow healthy cooking practices? | |||||
| 37 | Does your on-site cafeteria set nutritional standards that align with the Dietary Guidelines for Americans? | |||||
| 38 | Do you label food to show appropriate serving size and calories, and provide employees with food models, pictures or portable food scales for weighing portion sizes? | |||||
| 39 | Do you offer healthy food options at meetings and company events? | |||||
| # | Wellness Component | Yes | In Process | No | Potential Priority | Comments |
| 40 | Do you make water available throughout the day? | |||||
| 41 | Do you make kitchen equipment (refrigerators, microwaves, stoves, etc.) available to employees for food storage and cooking? | |||||
| 42 | Do you offer locally grown fruits and vegetables on-site? | |||||
| 43 | Do you provide on-site gardening? | |||||
| 44 | Do you provide interactive food opportunities, such as taste-testing, food preparation skills and peer-to-peer modeling? | |||||
| 45 | Do you have workplace policies and programs that promote breast-feeding? | |||||
| 46 | Do you provide an appropriate place for breast-feeding or pumping? | |||||
| 47 | Do you provide lactation education programs? | |||||
| 48 | Do you provide incentives for participation in nutrition and weight management activities? | |||||
| 49 | Do you include the employees’ family members in campaigns promoting fruit and vegetable consumption? | |||||
| Nutrition area totals (number of “yes,” “in process” and “no” items) | ||||||
| Health Screening and Disease Prevention and Management | ||||||
| 50 | Do you offer health risk assessments? | |||||
| 51 | Do you offer easy access to free or reasonably priced health screenings? | |||||
| Screening area totals (number of “yes,” “in process” and “no” items) | ||||||
| # | Wellness Component | Yes | In Process | No | Potential Priority | Comments |
| Tobacco Use | ||||||
| 52 | Do you prohibit tobacco use anywhere on your property? | |||||
| 53 | Do you post prompts or posters to support your no tobacco use policy? | |||||
| 54 | Do you promote the Tobacco Quit Line (800-QUIT-NOW)? | |||||
| 55 | Do you support participation in smoking cessation activities during work hours (flex time)? | |||||
| 56 | Do you provide counseling through an individual, group or telephone counseling program on-site? | |||||
| 57 | Do you provide individual, group or telephone counseling sponsored through your health plan? | |||||
| 58 | Are smoking cessation medications covered through your health plan? | |||||
| Tobacco area totals (number of “yes,” “in process” and “no” items) | ||||||
| Cardiac Emergency Response Plan | ||||||
| 59 | Do you have a written plan for emergency response to cardiac events? | |||||
| 60 | Do you provide emergency training in cardiopulmonary resuscitation (CPR) and/or automated external defibrillators (AEDs) for response to cardiac events? | |||||
| Cardiac response totals (number of “yes,” “in process” and “no” items) | ||||||
| Worksite Scorecard (Totals of all categories) |
Yes | In Process | No | Potential Priority | Comments |
| General (10) | |||||
| Physical Activity (29) | |||||
| Nutrition (19) | |||||
| Health Screening and Disease Prevention (2) | |||||
| Tobacco Use (7) | |||||
| Cardiac Emergency Response Plan (2) | |||||
| Worksite Total (60) |
