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  Holland Hospital
  602 Michigan Ave.
  Holland MI 49423
  (616) 392-5141
  info@hollandhospital.org

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Worksite Wellness Survey

1. How many employees are employed at your worksite?
  a. <50
  b. 51-200
  c. 201-500
  d. 501-1000
  e. >1001
2. What type of industry is your business?
  a. manufacturing
  b. service
  c. education
  d. health care
  e. agriculture
  f. other (please list):
3. What is your title/role at the worksite?
  a. HR manager
  b. HR generalist
  c. wellness coordinator
  d. other (please list):
4. Do you have a wellness budget?
  a. Yes
  b. No
5. Do you have a dedicated wellness coordinator?
  a. Yes
  b. No
6. In the past 18 months, has your worksite offered any classes, presentations or programs to improve the health of employees?
  a. Yes
  b. No
7. In the past 18 months, has your worksite offered any screenings or assessments to improve the health of employees?
  a. Yes
  b. No
8. In the past 18 months, has your worksite offered health or wellness coaching to employees?
  a. Yes
  b. No
9. Do you anticipate offering any of the above wellness activities in the next 1-3 years?
  a. Yes
  b. No
    i. If yes, what do you anticipate offering?
1. health improvement educational materials via newsletters, posters, table tents, & paycheck stubs
2. classes, presentations or programs
3. health screenings, assessments or health appraisals
4. wellness coaching
5. other (please list):
10. Are you interested in attending informal meetings to network with other professionals working to improve the health of employees?
  a. Yes
  b. No
    i. If yes, how often?
1. monthly
2. quarterly
3. 1-2 times/year
    ii. What topics would you like to discuss?
1. programs to encourage healthy eating
2. programs to encourage physical activity
3. going smoke free campus/ organization wide
4. health risk appraisals
5. wellness coaching
6. improving participation in wellness programs
7. incentives
8. bona fide wellness programs
9. other (please list):
11. Are you familiar with the programs and services that Holland Hospital Center for Good Health offers to area businesses?
  a. Yes
  b. No
    i. Would you like to receive the following:
1. Materials describing our services via postal mail (Send contact info)
2. A call from a health educator to discuss our services (Send contact info)
12. Are there programs and services that you would like to see Holland Hospital Center for Good Health offer to support the health of your employees?
  a. Comprehensive wellness program design & management (Send contact info)
  b. Wellness educational materials for distribution to employees (Send contact info)
  c. Other (please list):
13. In choosing a wellness vendor, what is most likely to influence your selection? Please rank in order of importance, 1 - greatest influence to 5 - least influence:
  a. Availability of outcome data
  b. Range/types of services provided
  c. Cost
  d. Quality of wellness education provided to employees
  e. Availability of prepackaged programs and ease of administration
  f. Capacity to interface with regional health care providers
   

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