Wellness Committee Guide 1-17-12 - Eat Smart, Move More NC

WELLNESSCOMMITTEEGUIDE

TABLE OFCONTENTSI. What Is a Worksite Wellness Program?.................................. 1II. What Is a Worksite Wellness Committee?.............................. 3III. Establishing and Maintaining....................................................... 5a Worksite Wellness CommitteeStep 1. Identifying Committee Members............................................................ 8Step 2. First Meeting—Establishing the Committee........................................10Step 3. Second Meeting—Obtaining Employee Opinions...............................14Step 4. Third Meeting—Developing an Action Plan.......................................18Step 5. Fourth Meeting—Updating Program Progress.....................................21Step 6. Fifth Meeting—Updating and Evaluating Program Progress..............22Step 7. Year End Meeting—Evaluating Overall Program...............................24IV. Appendices...................................................................................................27Appendix A: Five Components to a Comprehensive Program.....................28Appendix B: Wellness Committee Action Plan Template............................29Appendix C: Wellness Committee Action Plan Sample...............................31Appendix D: Sample Letter of Invitation to Serve........................................33on the Wellness CommitteeAppendix E: Wellness Committee Member Invitation Poster......................34Appendix F: Wellness Committee Member List...........................................35Appendix G: First Meeting—Sample Agenda...............................................36Appendix H: Sample Mission Statements......................................................37Appendix I:Employee Interest Survey.........................................................38Appendix J: Policy and Environment Survey...............................................40

TABLE OF CONTENTS, CONTINUEDAppendix K: A Guide to Making Physical Activitya Part of Meetings.....................................................................42Appendix L: Committee Members and Role Sharing Ideas.........................48Appendix M: Employee Interest Survey Distribution and Collection...........49SuggestionsAppendix N: Worksite Wellness Committee Announcement Poster............50Appendix O: Cover Letter for Employee Interest Survey.............................51Appendix P: Second Meeting—Sample Agenda..........................................52Appendix Q: Score Sheet for Employee Interest Survey..............................53Appendix R: Score Sheet for Policy and Environment Survey....................55Appendix S: Employee Evaluation of a Worksite Activity..........................56Appendix T: Employee Satisfaction with Worksite Wellness Program.......57Appendix U: Employee Satisfaction Survey Results Form...........................58Appendix V: Evaluation of Wellness Committee..........................................59by Committee Members

SECTION IWhat Is aWorksiteWellnessProgram?Wellness Committee Guide 1

What Is a WorksiteWellness Program?worksite wellness program is an organizedA program for employees designed to enrichtheir physical, mental, emotional, occupational andspiritual well-being.A major goal of the program is to make the workenvironment more supportive of positive healthbehaviors of employees and thereby reduce theirrisk of developing chronic diseases. The concept ofwellness, however, goes beyond reducing diseaseand includes promoting and supporting improvedwell-being for all employees.Even healthy employees will welcome theopportunity to work in an environment that supportstheir healthy lifestyle goals. Worksite Wellnessactivities can help all employees increase theirenergy and reduce stress.The WorkWell NC Wellness Committee Guideprovides the resources and tools to conduct worksitewellness programs and activities. These resourcesand tools have been designed utilizing the fivecomponents of comprehensive programs outlinedbelow.FIVE COMPONENTS OF COMPREHENSIVE PROGRAMS1. Health EducationExamples: Health promotion literature,newsletters, seminars, education sessions such aslunch-n-learns, classes or lectures, etc.2. Supportive Social and Physical EnvironmentsExamples: Incentives, walking/running groups,exercise or fitness classes/groups, facilities(showers, locker rooms, on-site gyms, etc.)offered, bike racks or storage, gym memberships,food services and facilities (cafeterias, vending,preparation and storage) offered, lactationsupport, tobacco-free facilities, etc.3. Integration of Worksite Program intoOrganizational StructureExamples: Existence of formal health andwellness policies, dedicated staff and employeesplan programs, management and supervisors areinvolved in planning and support implementation,employee access and program utilization isencouraged4. Linkages with Related Programs(EAP, Safety, etc.)Examples: Employee assistance, occupationalhealth and safety programs, health benefits orflexible spending accounts, flexible/telecommuteschedules, or other programs5. Screening ProgramsExamples: Mental health, blood pressure,diabetes, substance abuse, mammography, stress,cholesterol, Health Risk Appraisal, etc.Key Item to Remember:As employees’ behaviors change and theirhealth improves, it is critical that the policies,practices and physical environment of theworksite also change to support the individualhealth improvements. One cannot achievesuccess and sustainability without the other.2WorkWell NC

SECTION IIWhat Isa WorksiteWellnessCommittee?Wellness Committee Guide 3

What Is a WorksiteWellness Committee?THE WORKSITE WELLNESSCOMMITTEE• is a team of employees who formally meet and plan activitiesto promote good health for themselves and for their fellowworkers,• represents employees from all organizational levels,• communicates to employees information about known healthrisks and the value of a worksite wellness committee andwellness initiatives,• creates and maintains open lines of communicationbetween wellness committees and employees,• promotes participation in both individual and groupactivities,• advocates for worksite policies and environments that supportimproved health,• coordinates the monitoring and evaluation ofthe wellness activities/programs offered toemployees, and• serves as the leader/champion for wellnessactivities at their worksite.The WorkWell NC Wellness Committee Guideprovides the resources and tools for worksitewellness committees to establish, maintainand sustain a successful worksite wellnessprogram.Worksite Wellness—Commitment and SupportEstablishing, supporting and maintaininga worksite wellness committee providesopportunities for all employees (both managementand staff) to:• create a healthy worksite;• foster collaboration and partnerships; and• establish healthy lines of communicationbetween support staff, line supervisors, middleand top management.4WorkWell NC

SECTION IIIEstablishingand Maintaininga WorksiteWellnessCommitteeWellness Committee Guide 5

Step-by-Step InstructionsThe WorkWell NC Wellness Committee Guiderecommends the following steps to establish asuccessful worksite wellness committee and to supporthealthy lifestyle behaviors among the worksiteemployees.SAMPLE Wellness Committee Action PlanOrganization: ABC CorporationProgram Coordinator: Sally Jo SmithPlanning Chairperson: Bruce MorganPeriod Beginning: January 1, 2011Period Ending: December 31, 2011Vision Statement:To provide a work culture that supports our employees’ health.Goals:1. Improve access to healthy foods and beverages during the work day2. Encourage employees to be physically active during the work dayTHE STEPS:1. Identifying Committee Members and Prepare forInitial Meeting2. First Meeting—Establishing the Committee3. Second Meeting—Obtaining Employee Opinions4. Third Meeting—Developing an Action Plan5. Fourth Meeting—Updating Program Progress6. Fifth Meeting—Updating Program Progress7. Year End Meeting—Evaluating Committee ActivitiesPeriod Budget:$500.00Overall Marketing and Communications Strategies:• Establish a bulletin board for print announcements, flyers and general wellness information.• Establish a posted calendar mark the start and end date of all activities.• Establish wellness updates as a standing agenda item for all staff meetingsA Year in the Life of a Worksite Wellness CommitteeStep 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 1AprilIdentifyingCommitteeMembersand Preparefor InitialMeetingMayEstablishinga WorksiteWellnessCommitteeJulyObtainingEmployeeOpinionsSeptDevelopingan ActionPlanNovUpdatingProgramProgressJanUpdatingProgramProgressMarchCompletingthe 12MonthEvaluationAprilIdentifyingCommitteeMembers,etc.6WorkWell NC

Worksite Wellness Committee—Key Items to Remember• In order to establish an effective worksite wellness committee, the committee members shouldplan to complete the steps in the The WorkWell NC Wellness Committee Guide over a twelvemonthperiod. The proposed steps are flexible and can be altered to accommodate the needs ofyour worksite wellness committee.• There are a minimum of six recommended meetings that should be held within this time period.This timeline may need to be expanded, for example, to include at least one meeting per monthlasting at least one hour in duration. The number of meetings may depend on survey results andfindings by the worksite wellness committee.• The Worksite Wellness Committee Action Plan (Appendix B and Appendix C) is critical tothe guidance and success of program activities, the evaluation of those activities and reportingresults to management.• After the wellness committee has completed the first year, the committee can continue to usethe workbook as a guide for years two, three and so on.• The committee workbook has been created so that committee members can rotate off and newemployees can rotate onto wellness committees. The committee workbook is an easy to followguide for new committee members and helps to ensure sustainability of the worksite wellnessprogram.• Worksites that have an established wellness committee can utilize this workbook as a resourceto review their current committee work and are encouraged to use these tools to enhance theircommittee work.• All committees—new or established—can utilize the agendas, surveys, resources and ideasprovided in the toolkit.WELLNESS COMMITTEE GUIDE 7

Email ___________________________________ Phone ___________________________________Step 1: Identifying CommitteeMembers and Getting StartedThis committee guide is designed so that anyoneat your worksite can begin the process ofestablishing a Wellness Committee, but it may benecessary to allow management to identify initialcommittee members.Identifying committee members can beaccomplished in two ways: by invitation and/orsoliciting volunteers. Consider the followingwhen identifying people to serve on the wellnesscommittee:1. Invite staff members to serve on the wellnesscommittee. Staff members should be asked, inperson or by letter, about their willingness andinterest to serve. See Appendix D for a samplecommittee invitation letter.newsletters, via e-mail, or by other means.Committee members who volunteer can becomeprogram “champions” encouraging successfor the entireworksite.Volunteers havethe potential tobring increasedenergy to thecommittee. SeeAppendix Efor a samplecommitteerecruitmentannouncement.__________________________________________________________________________________(name of worksite)has a golden opportunity to Work Well.Do YOU want to be aleader in realizing theWorkWell NC goal?Join theWorksite WellnessCommitteeContact __________________________________________________________________________to learn more about the program and the responsibilities of serving on theworksite wellness committee.Contact: ____________________________________________________________________________2. Solicit volunteers by placing announcementsin high traffic locations, through employeeIdentifying Committee Members—Key Items to Remember• Number of Committee Members—It isrecommended that you have between fourand twelve committee members, althoughthis number may depend on the size of yourworksite.• Suggested Committee Members—Includecommittee members from all departments(human resources, information support, etc.).Also include members of management andsupport staff.• Existing Committees—If you haveexisting committees, such as a safety orsocial committee, target these members forinvitation.• Supervisor Approval—All committeemembers should have their immediatesupervisor’s support for the time and workthey dedicate to the wellness committee.• Work Plan Revision—Employees may needto revise their annual work plan to reflect theduties of serving on the wellness committee.8WorkWell NC

WORKSITE WELLNESS COMMITTEE MEMBERSName of Worksite _____________________________________________________________________Member Name Supervisor Approval Workplan Revision1.2.3.4.5.6.7.8.9.10.Once committee members have been identified,be sure to complete the Worksite WellnessCommittee Members’ Form (Appendix F), listingthe committee members’ names with managementapproval, and any necessary workplan revision.11.12.Now, Get Started!Now that committee members have been recruited,your first goal is to prepare for your first meeting.This may seem relatively simple, but it is the mostcritical part of the process.• Schedule a date, time, and place that is convenientfor all committee members. Allow one to twohours for this initial meeting. As you will seein Step 2, this amount of time is essential inestablishing an effective and organized worksitewellness committee.• The individual who recruited initial wellnesscommittee members may facilitate the firstmeeting, where a committee chairperson will beselected.• Step 2 of this Committee Guide provides detailedinformation about the first meeting in addition to asample agenda.Getting Started—Key Items to RememberAll items from this Committee Guide andadditional materials to support your WellnessCommittee can be downloaded for free atwww.eatsmartmovemorenc.com/Worksites.html.WELLNESS COMMITTEE GUIDE 9

Step 2: First Meeting—Establishing the CommitteeAs a member of management and/oremployee who has been selected to convenethe first meeting of the wellness committee,you should provide an overview/orientationto other committee members about theorganization and utilization of the WorkWell NCWellness Commitee Guide. This task should beaccomplished in the first committee meeting.The objectives and detailed points ofdiscussion for the first meeting are providedbelow. A sample agenda for the meeting is alsoprovided in Appendix G. It can be printed fromwww.eatsmartmovemorenc.com/Worksites.htmlfor distribution during the committee meeting.You can also modify the objectives and theagenda to better suit the needs and organizationof your particular worksite.MEETING OBJECTIVES• Overview and orientation of worksite wellnessprogram and toolkit• Identify worksite wellness committeechairperson and program coordinator• Select a name for the committee and write amission statement (Appendix H)• Develop a communication plan to announcethe program/activities to employees• Introduce the Worksite Wellness CommitteeAction Plan (Appendices B and C)• Introduce Employee Interest Survey(Appendix I)• Introduce and distribute Policy &Environmental Survey to committee members(Appendix J)AGENDA ITEMS1. Call meeting to order (5 minutes)The facilitator of the meeting should ask for a volunteer to recordthe minutes of the meeting.2. Introductions—Committee Members (10 minutes)Each employee introduces himself or herself and shares onefavorite food and one favorite physical activity. (See Appendix Kfor additional physical activity breaks.)Committee Communication: Pass around the Worksite WellnessCommittee Members Form (Appendix F) for members to list theirname.WELLNESS COMMITTEE MEETINGAGENDAWorksite Name: __________________________________________________Date: _________________________ Time: ____________________________Call meeting to orderIntroductions—Committee MembersShare your name, department, favorite food and one favorite physical activitySign Committee Communication list—name, email address and phone numberOrientation to Work Well NC Wellness Committee Guide5 Components of a Comprehensive Program (Appendix A)Overview of the Work Well NC resources available at eatsmartmovemorenc.com/Worksites.htmlCommittee NameMission StatementCommittee Chairperson and Program Coordinator SelectionEmployee Communication PlanOverview of Action Plan and SurveysWorksite Wellness Committee Action Plan (Appendix B)Worksite Wellness Committee Action Plan Sample (Appendix C)Employee Interest Survey (Appendix I)Policy and Environment Survey (Appendix J)Schedule Future MeetingsAdjourn3. Orientation to the WorkWell NC Wellness Commitee Guide(20 minutes)Introduce the WorkWell NC Wellness Commitee Guide tocommittee members.• 5 Components of a Successful Program (Appendix A)• Introduce committee members to the tools available on the web at:www.eatsmartmovemorenc.com/Worksites.html.10WorkWell NC

4. Committee Name (10 minutes)Select a name for the worksite wellness committee.Name_______________________________________________________5. Mission Statement (15 minutes)The mission statement should be aglobal expression of what the WorksiteWellness Committee wants to accomplish.The mission statement may include adescription of the value of the programto the worksite and employees. Youmay decide on a mission statement thatreflects the work the committee wants toaccomplish. Some examples of missionstatements are given on the right and inAppendix H. You may choose to selectone from these or create your own.6. Selection of Committee Chairperson(10 minutes)Select the Worksite Wellness CommitteeChairperson. The chairperson isresponsible for conducting the meeting(s)and handling any administrative paperworkand reporting for the committee.Committee Chairperson:Mission Statement Examples• “The mission of the (name of worksite) WorksiteWellness Committee is to establish and maintain aworksite that encourages environmental and socialsupport for a healthy lifestyle.”• “To encourage employees’ personal and professionalproductivity, and physical and mental well-being, themission of the (name of worksite) Worksite WellnessCommittee shall be to promote a worksite culturethat supports employees’ desire to make healthylifestyle choices.”• “Because employees spend 40 hours a week at work,it is important that the worksite be a healthy placeto work and support healthy choices for employees.It is the mission of the (name of worksite) WorksiteWellness Committee to work toward implementingpolicies that support a healthy worksite and healthyemployees.”__________________________________This person will:• not need a background in health—thisguide is self-directing,• send committee meeting reminders,meeting minutes and other detailsdocumenting the wellness committee’s work,• distribute, collect and score the Policy and Environmental Survey (thissurvey is completed by committee members only—Appendix J),• coordinate employee program activities, with the help of the programcoordinator (see page 12) and,• submit documents to management for program evaluation such as notesor minutes from meetings, sample email messages, etc.• “The worksite wellness committee will work toprovide opportunities for employees to develophealthier lifestyles by supporting the adoption ofhabits and attitudes that contribute to their positivewell-being.”WELLNESS COMMITTEE GUIDE 11

7. Selection of the Worksite Wellness Program Coordinator. (10 minutes)The program coordinator (one or more persons for large worksites—see Appendix L for role sharing ideas) will serve as the overallcoordinator for the program activities.Program Coordinator(s):__________________________________________________________This person will:• not need a background in health—these resources are self-directing,• devote time in his or her regular work schedule to addresscoordination responsibilities,• distribute, collect and score the Employee Interest Survey(Appendix I) which will be distributed to all employees at theworksite (see Appendix M for methods of distribution, collection andscoring of surveys), and• coordinate employee program activities,with the help of the committee chairpersonand/or other program chairs as assigned.8. Employee Communication Plan(10 minutes)Establish a plan for communicating withemployees that• announces the formation (or continuation)of the wellness committee (Appendix N),• provides information to employees aboutupcoming programs and events, and• provides employees with periodic updatesabout the worksite wellness program.9. Action Plan Template and Sample (5 minutes)Provide a copy of the Worksite Wellness Committee Action Plan Template(Appendix B) and Action Plan Sample (Appendix C) forcommittee members to review for the next meeting.10. Employee Interest Survey (10 minutes)Provide a copy of the Employee Interest Survey (Appendix I)and the accompanying cover letter (Appendix O) to all committeemembers to review before the next meeting. The results of this survey will help the committee determine theshort-term goals for the Worksite Wellness Committee Action Plan. Ask that committee members review the survey and think abouthow this survey should be distributed to employees at your worksite.This may be done personally, through email, mailboxes or someother practical means depending upon the size of your worksite andthe number of employees. (See Appendix M for suggested surveydistribution and collection suggestions.)Examples of ways to communicatewith employees include:• Kick-off events• Announcementsthrough agency“intranet” service• Posters on bulletinboards, entrance doorsand restroom doors• Newsletter articlesWORK WELL NC• Email announcements• Employee letters• Payroll stuffers• Intercomannouncements• Staff meetings• Employee celebrationsEmployee Interest SurveyDirections: Indicate your interest for each of the following by circling:1: little or no interest 2: some interest 3: very interestedI am interested in:ATTENTIONIT’S COMING!YourWorksiteWellnessProgramWorkWell NCWorksite Wellness Coordinator______________________________________________________________________________________Worksite Wellness Committee Members_________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _________________________________________1 2 32. learning how to incorporate fruits and vegetables into my diet. 1 1 2 31. learning more about healthy food 2 33. learning about healthier food choices and portions to help manage my weight.1 2 34. participating in “tasting” events to sample healthy foods. 1 2 35. having healthy snacks available for purchase at work. 1 2 36. learning more about the benefits of physical activity and how it can influence my health.1 2 37. increasing my physical activity level. 1 2 38. walking to increase physical activity. 1 2 39. participating in team activities. 1 2 310. learning ways to cope with feelings of stress. 1 2 311. time management skills. 1 2 312. improving my communication skills. 1 2 313. learning skills to cope with change. 1 2 314. organized social events with my co-workers. Events might be holiday party or summer picnic.1 2 315. participating in wellness activities within my regular work schedule. 1 2 316. participating in wellness activities before work 1 2 317. participating in wellness activities after work. 1 2 318. 10-15 minute activities that I can do two to three times a day. 1 2 319. activities that last 30–60 minutes. 1 2 320. health information that I can read, listen to, or watch on my own.1 2 321. participating with a group to learn more about wellness. Continued12WorkWell NC

11. Policy & Environmental Survey (10 minutes)Distribute a copy of the Policy and Environmental Survey (Appendix J)to the committee members. The committee members need to completethis survey and return to the committee chair by a specified date (beforethe next meeting so the chair will have time to compile the results fordiscussion at that meeting). The results of this survey will help the committee determine thelong-term goals for the Worksite Wellness Committee Action Plan.12. Schedule Future Meetings (10 minutes)It is recommended that the committee members schedule the futurefive committee meetings at this point. The second meeting should bescheduled within one month of the first meeting. Allow 60-90 minutesfor each meeting.The following timeline is suggested over a twelvemonthperiod:WORK WELL NCPolicy & Environment SurveyDirections: • This survey is completed by the worksite wellness committee members only.• Please circle your answer to each of the questions.• Choose N/A on any question that does not apply to your worksite.1. Does your worksite have any written policy or policies recommending Yes No Not Sure N/Athe use of healthier foods for holiday celebrations or staff meetings?2. If Yes, are employees told about the healthy foods policy or policies Yes No Not Sure N/Aduring orientation?3. Does your worksite have a refrigerator designated for food for Yes No Not Sure N/Aemployees to use?4. Does your worksite have any equipment and sink access available Yes No Not Sure N/Afor employees to use to prepare and eat meals?5. Does your worksite have any vending machines? Yes No Not Sure N/A6. If Yes, do the vending machine(s) offer at least 5 healthy choices? Yes No Not Sure N/AHealthy choices include fresh fruits, whole grain chips, or baked chips, etc.7. Does your worksite have a cafeteria? Yes No Not Sure N/A8. If Yes, Does your cafeteria offer at least 5 healthy choices like 100% Yes No Not Sure N/Ajuice products, fresh fruits, or whole grain products?9. Has information on healthy food choices been provided to employees Yes No Not Sure N/Ain the past year?How? _________________________________________________10. Does your worksite have any written policy or policies encouraging Yes No Not Sure N/Aphysical activity during the workday?11. Does your worksite have stairs? Yes No Not Sure N/A12. If yes, are the stairs safe, clean and well-lit? Yes No Not Sure N/A13. Does your worksite have a safe place for walking or other activities Yes No Not Sure N/Aon-site or near-by?Name of near-by facility14. Does your worksite sponsor any physical activities, teams or clubs? Yes No Not Sure N/AName of activity: ______________________________________15. Does your worksite sponsor any community-based activities, teams Yes No Not Sure N/Aor clubs?Name of activity: ______________________________________Continued• Second meeting—month 2_________________________________________________________• Third meeting—month 3_________________________________________________________• Fourth meeting—month 6_________________________________________________________• Fifth meeting—month 9_________________________________________________________• Year-end meeting—month 12_________________________________________________________13. AdjournReminder: The chairperson should send ameeting reminder notice to all committeemembers at least one week prior to the nextmeeting. Minutes from this meeting can beincluded with that reminder.As a Reminder:All WorkWell NC materials, including thiscommittee guide, are available for free download atwww.eatsmartmovemorenc.com/Worksites.html.All files are available in PDF format for downloadingand printing. All agendas, letters, posters, as well asall the resources, are available for easy use.WELLNESS COMMITTEE GUIDE 13

Step 3: Second Meeting—Obtaining Employee OpinionsObtaining Employee Opinions—Key Items to RememberThis meeting will accomplish several majortasks for the committee:1. The Employee Interest Survey will bediscussed and distributed to all employeesat your worksite after this meeting. As acommittee chairperson and/or member,it is critical that you support the work ofyour committee and encourage your fellowemployees to complete the survey.This is the key document for engagingemployees in the wellness activities selectedfor their worksite, and finding out theirinterests and needs will contribute to theoverall success of the committee’s work andthe worksite wellness program. The resultsof this survey will guide the committee’sshort-term goals for your action plan andthe selection of the activities that will beintroduced at the worksite.2. The Policy & Environmental Survey resultswill be reviewed to help the group developlong-term goals for the action plan regardingpolicy/environment changes. The results ofthe survey may very well show that thereare several issues that need to be addressed;however, it is good to strive for one changeat a time. As policy/environment changes areadopted (either formally or informally), newaction plans can be created to address otherissues.3. Incentives and Work Time Considerationsfor Activities may be discussed. This willvary from worksite to worksite and is oneof the tasks that will involve management’sinput. As a reminder, the toolkit is equippedwith all the resources you need to startwellness activities at your worksite. Incentivesand resources are an added bonus to yourprogram, should they be available.The objectives and detailed points of discussionfor the second meeting are provided below.A sample agenda for the meeting is also providedin Appendix P. You can also modify the objectivesand the agenda to better suit the needs andorganization of your particular worksite.MEETING OBJECTIVES• Outline plan to distribute and collect the EmployeeInterest Survey• Review results from the Policy & EnvironmentalSurvey• Identify funds for incentives and materials• Discuss current and potential worksite policy forwellness activities14WorkWell NC

AGENDA ITEMS1. Call meeting to order—Chairperson (5 minutes)The committee chairperson should ask a volunteer to record the minutesof the meeting.2. Old Business—Chairperson (5–10 minutes)Discuss any unfinished tasks from the previous meeting as indicated inthe minutes. Make a note of them here:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________3. Employee Interest Survey—Program Coordinator (10 minutes)• Decide how to distribute the survey to employees at your worksite.This may be done personally, through e-mail, mailboxes or some otherpractical means depending upon the size of the facility and number ofemployees. (Review Appendix O for survey distribution and collectionsuggestions.)• Decide the dates that the surveys will be distributed and when theyshould be completed and returned. Allow at least one week foremployees to complete and return the survey to the specified person.Also, the return date should be such that it gives a reasonable amountof time for the Program Coordinator to compile the results for thenext committee meeting. Be sure to include this date on the survey inthe space provided before sending them out to the employees.• The program coordinator distributes, collects and scores the surveyand reports the results at the next meeting. The score sheet for theEmployee Interest Survey is provided in Appendix R.• The results of the Employee Interest Survey will be reviewed at thenext meeting and will be used by the committee to determine theshort-term goals (strategies) for the Action Plan.4. Worksite Policy & Environmental Survey Report—Chairperson (20 minutes)The committee chairperson should have received the completedworksite Policy and Environmental Survey from all thecommittee members before this meeting. Also, using thesurvey score sheet (provided in Appendix Q), the chairpersonshould have arrived at the results for the survey. Discuss theseresults with the committee members.Score Sheet for Policyand environment SurveyEmployEE IntErEst survEy scorE shEEtName of Worksite _____________________________________________Total Number of Surveys Distributed ________________Total Number of Surveys Returned _________________Directions1. Collect all completed Employee Interest Surveys.2. For each question, add the response number that has been circled on all surveys. This will give you thefinal score for each one of the questions from 1 to 27.3. For example, if you collect 3 completed surveys and the responses for Question 1 on these surveys are:3, 2 and 3, then the score for Question 1 is 3+2+3 = 8.EAT SMART1. I am interested in learning more about healthy food choices.2. I am interested in learning how to incorporate fruits and vegetables into my diet.3. I am interested in learning about healthier food choices and portions to helpmanage my weight.4. I am interested in participating in “tasting” events to sample healthy foods.5. I am interested in having healthy snacks available for purchase at work.MOVE MORE6. I am interested in learning more about the benefits of physical activity.7. I am interested in increasing my physical activity level.8. I am interested in walking to increase physical activity.9. I am interested in participating in team activities.MANAGE STRESS10. I am interested in learning ways to cope with feelings of stress.11. I am interested in time management skills.12. I am interested in improving my communication skills.13. I am interested in learning skills to cope with change.14. I am interested in organized social events with my co-workers.Events might be holiday party or summer picnic.WHEN EMPLOYEES WOULD MOST LIKELY PARTICIPATE IN PROGRAMS15. I am interested in participating in wellness activities within my regular work schedule.16. I am interested in participating in wellness activities before work.17. I am interested in participating in wellness activities after work.Name of Worksite _______________________________Number of Completed Surveys ____________________Count the total number of “NO” answers for questions 1–9for all surveys completed by the committee members.This is the EAT SMART score Out of possible score = 9Count the total number of “NO” answers for questions 10–15for all surveys completed by the committee members.This is the MOVE MORE score Out of possible score = 6Count the total number of “NO” answers for questions 16–19for all surveys completed by the committee members.This is the MANAGE STRESS score Out of possible score = 4Count the total number of “NO” answers for questions 20–24for all surveys completed by the committee members.This is the QUIT NOW score Out of possible score = 5Look at the scores for all the four policy/environmental areas. High numbers indicate areas where policyand environmental changes are needed the most to make your workplace a healthier one.Suggestions and ready-to-use resources for worksite policy and environmental changes in each of the fourareas are provided at www.eatsmartmovemorenc.com/Worksites.html.WELLNESS COMMITTEE GUIDE 15

• Report the total score for each of the followingfrom the survey score sheetEat SmartMove MoreManage StressQuit Now________________________________________________________________________Note: The four focus areas are listed on thescore sheets in the same order as the surveyquestions. In both the Employee InterestSurvey and the Policy and EnvironmentalSurvey the tobacco use questions were listedlast as not all employees use tobacco.• A high score in any of the sections indicates that the committee needsto consider selecting long-term goal(s) for promoting policy and/orenvironmental changes at the worksite. Refer to the Sample Action Plan(Appendix C) for examples.Next, select activities that correspond to the committee’s long-termgoal(s). Visit www.eatsmartmovemorenc.com/Worksites.html forprogram policy and environmental change suggestions. Refer to theSample Action Plan (Appendix C) to see how the strategies and stepswill be reported on your action plan.Make a list of the strategies and steps that your worksite wellnesscommittee plans to implement. Record these on your Action Plan(Appendix B).Once the committee has determined the long-term goals for yourworksite, record the strategies on your action plan that will becompleted at the next meeting.5. Management Issues—Chairperson (30 minutes)The chairperson may need to assign one or two members of thecommittee to follow up on the questions below and others that might ariseduring discussion for reporting at the next meeting.Funding for incentives and materials—Chairperson (15 minutes)1. What are the wellness committee’s funding needs?____________________________________________________________________________________________________________________________________________________2. Is funding available from management?____________________________________________________________________________________________________________________________________________________3. Is there any funding available from outside sources?____________________________________________________________________________________________________________________________________________________16WorkWell NC

Worksite policy for wellness activities—Chairperson (15 minutes)1. Who has authority to approve time considerations for activities during regular work hours?____________________________________________________________________________________________________________________________________________________2. What might be the restrictions regarding wellness activities at the worksite?____________________________________________________________________________________________________________________________________________________3. How much time is allowed for wellness activities—if any? Examples: 30 minutes peremployee 3 times a week; 15 minutes per employee daily paired with established breaktime; 1 hour all employees once a month for group activity.____________________________________________________________________________________________________________________________________________________6. Next meeting date(s)—Program Coordinator (10 minutes)The committee may have already decided the dates for the upcomingmeetings during the first meeting. However, it would be beneficial toreview these dates once again, both as a reminder and to provide anopportunity for any changes.Third meeting:Fourth meeting:Fifth meeting:__________________________________________________________________________________________________________________Year-end meeting: ______________________________________7. AdjournReminder: The chairperson should send a meeting reminder notice to allcommittee members at least one week prior to the next meeting. Minutesfrom this meeting can be included with that reminder.WELLNESS COMMITTEE GUIDE 17

Step 4: Third Meeting—Developing an Action PlanMEETING OBJECTIVES• Review results from the Employee Interest Survey• Identify short-term goals (based on EmployeeInterest Survey)• Review long-term goals (based on Policy andEnvironmental Survey)• Create an Action Plan for your worksite wellnessprogram• Schedule follow-up meeting to check progressAGENDA ITEMS1. Call meeting to order—Chairperson (5 minutes)The committee chairperson should ask for avolunteer to record the minutes of the meeting.2. Old Business—Chairperson (5-10 minutes)Discuss any unfinished tasks from the previousmeeting as indicated in the minutes._____________________________________________________________________________________________________________________3. Employee Interest Survey Report—ProgramCoordinator (20 minutes)The Program Coordinator should have receivedall completed Employee Interest Surveysfrom the employees at the worksite before thismeeting. Also, using the survey score sheet(Appendix Q), the Program Coordinator shouldhave arrived at the results for the survey.(Note: The Coordinator may have asked for helpfrom one or two other committee members toanalyze the results of this survey, depending uponthe size of the worksite and the response ratefor the survey. See Appendix O for additionalsuggestions.)Discuss these results with other committeemembers.• Total # of Surveys Distributed__________• Total # of Surveys Returned___________The score for each of the questions in theEmployee Interest Survey reflects the level ofemployee interest in that particular area. Highnumbers indicate higher level of interest. As ateam, look at the scores and identify the areasthat your worksite wellness committee would liketo address first.Report the total score for each of the followingfrom the survey score sheetEat SmartMove MoreManage StressQuit Now____________________________________________________________________________Note: The four focus areas are listed on thescore sheets in the same order as the surveyquestions. In both the Employee InterestSurvey and the Policy and EnvironmentalSurvey the tobacco use questions were listedlast as not all employee use tobacco.A high score in any of the sections indicates thatthe committee needs to consider selecting shorttermgoal(s) for promoting individual behaviorchange of employees. Refer to the Sample ActionPlan (Appendix C) for examples.18WorkWell NC

Next, select activities that correspond to the committee’s short-termgoal(s). The committee can utilize the resources found atwww.eatsmartmovemorenc.com/Worksites.html to plan short termgoals and programs.Refer to the Sample Action Plan (Appendix C) to see how thestrategies and steps will need to be reported on your action plan.Make a list of the strategies and steps that your worksite wellnesscommittee plans to implement.Once the committee has determined the short-term goals for yourworksite, the strategies and steps are ready to be recorded on youraction plan (Appendix B).4. Developing the Action Plan—Chairperson (20 minutes)Record the following information on Worksite Wellness CommitteeAction Plan (Appendix B):• Worksite• Committee Name• Committee Chairperson• Program Chair• Other Chairs• Mission Statement• Communication Plan• Committee Members• Short-Term Goals—Strategies and StepsDetermine committee members responsible for each strategyDecide date of implementationRecord results and outcomes after each activity• Long-Term Goals—Strategies and StepsDetermine committee members responsible for each strategyDecide date of implementationRecord results and outcomes after each activity• Year-End Evaluation Summary—to be completed at the last meeting• Recommendations from the Committee—to be completed at the lastmeeting5. Evaluate Employee Program ActivitiesBe sure to think about ways to get feedback from employees on theindividual and/or group activities that you implement at your worksite.One way is to have employees sign up for activities and provide theiremail addresses so that once the activity is completed, you can emailthem a short survey about the activity. (See Appendix S.)The evaluation information collected through employee feedback willneed to be summarized in the Results/Outcomes section of the actionplan. (See Appendix S for an example of a program/ activity evaluationAdopt and begin implementation of yourWorksite Wellness Committee Action Plan.WELLNESS COMMITTEE GUIDE 19

form.)6. Next meeting date(s)—Program Coordinator (5 minutes)Remind the committee members of the dates for future meetings to checkthe progress of the action plan. This will alsoprovide an opportunity to make any changes tothe scheduled dates, if needed.Fourth meeting:Fifth meeting:______________________________________________Year-end meeting: _______________________7. AdjournReminder: The chairperson should send a meetingreminder notice to all committee members at leastone week prior to the next meeting. Minutes fromthis meeting can be included with that reminder.Simple Guidelines forDocumenting Programs/ActivitiesBe sure to document all the events associatedwith any of the programs/activities that youimplement at your worksite. For example:• Write a short summary of the program activity.• Keep a list of all those who participate.Document the number of employees whoparticipate in each activity.• Take pictures at your event. This is a great wayto advertise and promote future events.• As soon as the activity is completed, haveemployees complete the Employee Program and/or Activity Evaluation survey. (Appendix S)• Review the evaluations and prepare a shortsummary of the successes and/or lessonslearned.• Record the information on the committee’saction plan.• Compile additional information about committeework in a binder.20WorkWell NC

Step 5: Fourth Meeting—Updating Program ProgressMEETING OBJECTIVES• Assess progress of the adopted action plan• Change or revise action plan if needed• Determine if new or additional strategies and stepsshould be initiatedAGENDA ITEMS1. Call meeting to order—Chairperson (5 minutes)The committee chairperson should ask avolunteer to record the minutes of the meeting.2. Old Business—Chairperson (5-10 minutes)Discuss any unfinished tasks from the previousmeeting as indicated in the minutes.__________________________________________________________________________________________________________________3. Action Plan Progress Update—ProgramCoordinator (40 minutes)• As a team review the implementation of theaction plan that was completed during the lastmeeting. The committee members may want todiscuss whether the strategies and steps werestarted and/or completed on the specifieddates and whether the employees are motivatedto participate in wellness program activities.• Also discuss any obstacles or problemsencountered in the implementation of theaction plan. This meeting should serve as anopportunity for the worksite wellness committeeto revise or update the action plan to bettersuit the needs of their worksite and employees.The committee should discuss the need forany changes to current strategies or addition ofnew strategies that would help to improve theeffectiveness of the worksite wellness program.The action plan should be updated to reflect anychanges or additions.______________________________________________________________________________________________________________________________________________________________________________________________4. Next meeting date(s)—Program Coordinator(5 minutes)Remind the committee members of thedates for upcoming meetings to asses furtherprogress of the action plan. It will also providean opportunity to make any changes to thescheduled dates, if needed.Fifth meeting:___________________Year-end meeting: ___________________5. AdjournReminder: The chairperson should send a meetingreminder notice to all committee members at leastone week prior to the next meeting. Minutes fromthis meeting can be included with that reminder.WELLNESS COMMITTEE GUIDE 21

Step 6: Fifth Meeting—Updating and EvaluatingMEETING OBJECTIVES• Assess progress of the adopted action plan• Change or revise action plan if needed• Determine if new or additional strategies and stepsshould be initiated• Decide on the overall worksite wellness programevaluation planAGENDA ITEMS1. Call meeting to order—Chairperson (5 minutes)The committee chairperson should ask avolunteer to record the minutes of the meeting.2. Old Business—Chairperson (5-10 minutes)Discuss any unfinished tasks from the previousmeeting as indicated in the minutes._____________________________________________________________________________________________________________________3. Action Plan Progress Update—ProgramCoordinator (25 minutes)• As a team review the implementation andprogress of the action plan. The committeemembers should discuss whether the strategiesand steps were completed on thespecified dates and whether the wellnessprogram is being accepted at the worksite.• Also at this point discuss any obstacles orproblems encountered in the implementation ofthe action plan. This meeting should serve as anopportunity for the worksite wellness committeeto revise or update the program action planto better suit the needs of their worksite andemployees. The committee should discussthe need for any changes to current activitiesor addition of new activities that would helpto improve the effectiveness of the worksitewellness program. The action plan should beupdated to reflect any changes or additions.___________________________________________________________________________________________________________________________________________________________________________________________________4. Overall Evaluation Plan—Chairperson(15 minutes)The worksite wellness committee should decideon a plan to evaluate the results of the overallwellness program conducted at the worksite.The committee can obtain information about theeffectiveness of the activities completed at theirworksite by:• repeating the Policy and Environment Surveyby committee members (Appendix J), and• conducting the Employee Satisfaction Survey(Appendix T).Since the next committee meeting will be the lastone for the current program year, these surveysshould be conducted before this meeting. Thiswill allow committee members time to discussthe results of the surveys and have programevaluation information to share during the lastmeeting.22WorkWell NC

Decide on the dates that these surveys will be distributed,collected and analyzed and the person(s) responsible.Survey Distribution Date/ Collection Date/ Analysis Date/Responsible Member Responsible Member Responsible MemberPolicy &EnvironmentSurveyEmployeeSatisfactionSurvey5. Next meeting date(s)—Program Coordinator(5 minutes)Remind the committeemembers of the datefor the next meeting toevaluate the impact andresults of the wellnesscommittee. This will alsoprovide an opportunityto make changes to thescheduled date, if needed.Year-end meeting:____________________6. AdjournReminder: The chairpersonshould send a meetingreminder notice to allcommittee members at leastone week prior to the nextmeeting. Minutes from thismeeting can be includedwith that reminder.Notes for Creatingthe Program Evaluation Plan• The Policy and Environment Survey (Appendix J) should becompleted by worksite wellness committee members only. TheEmployee Satisfaction Survey (Appendix T) should be distributedto all employees at the worksite. (See Appendix O for distributionand collection suggestions.)• Select the distribution dates about one month before the scheduleddate for the year-end meeting.• Also, the date by which the committee members/employees returnthe completed surveys should be at least two weeks prior to the lastmeeting. This will provide ample time for the committee member(s)responsible for analyzing the surveys.• The completed Policy and Environment Surveys can be scored usingthe score sheet provided in Appendix R. Ideally, the results shouldshow improved scores in the wellness topic that was targeted forintervention.• Before distributing the Employee Satisfaction Survey to employees,clearly specify the return date and name of the person responsible forcollecting the surveys on the survey form.• Depending upon the number of employees at your worksite, theanalysis of completed Employee Satisfaction Surveys may need timeinput from more than one committee member.• The results of the completed Employee Satisfaction Surveys can bereported using the outline provided in Appendix U. This will helpsimplify the evaluation of wellness program/activities during theyear-end committee meeting. It also provides an easy summary forreporting your results to othersWELLNESS COMMITTEE GUIDE 23

Step 7: Year End Meeting—Evaluating Committee ActivitiesTHE PROCESS OF PROGRAM EVALUATIONserves several purposes. It:• Helps the committee stay focused on short- andlong-term goals• Provides information for decision making on allaspects of the program• Identifies areas where the design and delivery ofactivities may need improvement or change• Increases the application of learning by participants• Allows for program accountability• Provides data on the major accomplishments of theprogram• Identifies way to improve future programsMEETING OBJECTIVES• Complete Year-End Evaluation SummaryEvaluate the Worksite Wellness Programusing the—Action Plan Results/Outcomes—Employee Satisfaction Survey—Policy and Environment Survey (Repeat)Provide recommendations from the Committeefor the next year• Schedule the Wellness Committee first committeemeeting for the upcoming year.AGENDA ITEMS1. Call meeting to order—Chairperson(5 minutes)The committee chairperson should aska volunteer to record the minutes of themeeting.2. Worksite Wellness ProgramEvaluation—Chairperson (20 minutes)• The program chair should report fromthe action plan the results/outcomes of allactivities and/or programs initiated.• The committee member(s) responsible forcollection and analysis of the EmployeeSatisfaction Survey and the repeat Policyand Environment Survey should presentthose results to the committee.Employee Satisfaction Survey results may bereported using the outline provided in AppendixU. The committee as a group should discuss andsummarize the results as recommendations for thenext year’s worksite wellness program.Successes:_______________________________________________________________________________________________________________________________________________________Barriers:_________________________________________________________________________________________________________________________________________________________24WorkWell NC

The repeated Policy and Environment Survey should have been analyzedusing the survey score sheet provided in Appendix R. Ideally, the resultsshould show improved scores in the wellness topic that was targeted forintervention.The committee should summarize and discuss these results. Compile themin a binder or folder for the next year’s wellness committee. Documentingsuccesses and barriers will help next year’s willness committee to planeffectively.Successes:________________________________________________________________________________________________________________________________________________________________________________________________________________________________Barriers:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________• The committee chairperson should ask for any other recommendationsto carry forward to the next year’s committee program of work.• The committee chairperson should complete the action plan byrecording the year-end evaluation summary information providedabove. A copy of the completed action plan should be sent to worksitemanagement.4. Next Year Implementation of the WorkWell NC Wellness CommitteeGuide—Chairperson (15 minutes)The year-end meeting should also serve as an opportunity for the worksitewellness committee members to realize that it is not the end of theworksite wellness program but a time to continue to build upon enhancingthe health of employees at their worksite.The committee members may wish to review the roles and responsibilitiesthat they fulfilled during the entire implementation period. Committeemembers may continue to serve on the committee or may choose to stepdown to open space for new members.It is suggested that the committee compile minutes, copies of surveys,survey reports, completed action plan and any other documents pertinentto the committee. These files can be recorded to CD or as hard copies in athree-ring binder.5. AdjournWELLNESS COMMITTEE GUIDE 25

26WorkWell NC

APPENDICESWellness Committee Guide 27

APPENDIX A: Five Components of Comprehensive ProgramsFive Componentsof Comprehensive Programs1. Health EducationExamples: Health promotion literature, newsletters, seminars, education sessionssuch as lunch-n-learns, classes or lectures, etc.2. Supportive Social and Physical EnvironmentsExamples: Incentives, walking/running groups, exercise or fitness classes/groups,facilities (showers, locker rooms, on-site gyms, etc.) offered, bike racks or storage,gym memberships, food services and facilities (cafeterias, vending, preparationand storage) offered, lactation support, tobacco-free facilities, etc.3. Integration of Worksite Programinto Organizational StructureExamples: Existence of formal health and wellness policies, dedicated staff andemployees plan programs, management and supervisors are involved in planningand support implementation, employee access and program utilizationis encouraged4. Linkages with Related Programs(EAP, Safety, etc.)Examples: Employee assistance, occupational health and safety programs, healthbenefits or flexible spending accounts, flexible/telecommute schedules, or otherprograms5. Screening ProgramsExamples: Mental health, blood pressure, diabetes, substance abuse,mammography, stress, cholesterol, Health Risk Appraisal, etc.28WorkWell NC

APPENDIX B: Wellness Committee Action Plan Template, page 1Wellness Committee Action PlanOrganization:Program Coordinator:Planning Chairperson:Period Beginning:Period Ending:Vision Statement:Goals:Period Budget:Overall Marketing and Communications Strategies:WELLNESS COMMITTEE GUIDE 29

APPENDIX B: Wellness Committee Action Plan Template, page 2Goal # _____:Strategy: Timeline: ResponsibleMemberStrategy: Timeline: ResponsibleMemberStrategy: Timeline: ResponsibleMemberBudget: Marketing andCommunicationsBudget: Marketing andCommunicationsBudget: Marketing andCommunicationsEvaluationStrategy:Final Results:EvaluationStrategy:Final Results:EvaluationStrategy:Final Results:30WorkWell NC

APPENDIX C: Wellness Committee Action Plan Sample, page 1SAMPLE Wellness Committee Action PlanOrganization: ABC CorporationProgram Coordinator: Sally Jo SmithPlanning Chairperson: Bruce MorganPeriod Beginning: January 1, 2011Period Ending: December 31, 2011Vision Statement:To provide a work culture that supports our employees’ health.Goals:1. Improve access to healthy foods and beverages during the work day2. Encourage employees to be physically active during the work dayPeriod Budget:$500.00Overall Marketing and Communications Strategies:• Establish a bulletin board for print announcements, flyers and general wellness information.• Establish a posted calendar mark the start and end date of all activities.• Establish wellness updates as a standing agenda item for all staff meetingsWELLNESS COMMITTEE GUIDE 31

APPENDIX C: Wellness Committee Action Plan Sample, page 2Goal # ___1__: Improve access to healthy foods and beverages during the work dayStrategy: Timeline: ResponsibleMemberBudget: Marketing andCommunicationsEvaluationStrategy:By July 2011, all snack Negotiations Sally Jo Morgan $ 0.00 1. Bulletin board 1. new contractand beverage vending complete by in coordination 2. Staff meeting 2. visualmachines will provide April 2011, with leadership updates inspectionat least 50% healthy Note: 3. Signagesnacks and beverages. New vending Consider a price in break roomavailable to staff adjustment to & on vending Final Results:by June 2011. boost revenue. machinesStrategy: Timeline: ResponsibleMemberBudget: Marketing andCommunicationsEvaluationStrategy:By February 2011, draft Draft by 2-1-11 Bruce Morgan $ 0.00 1. Educate all 1. new policyand adopt new policy to Supervisors 2. review foodrequire healthy food & Revise by 2-9-11 2. Staff meeting and beveragebeverage choices at all updates servedcompany sponsored Adopt by 3-1-11meetings and events. Final Results:Strategy: Timeline: ResponsibleMemberBudget: Marketing andCommunicationsEvaluationStrategy:By November 2011, host Locate provider Sally Jo Morgan 1. total eventsa minimum of 3 lunch by 2-15-2011. 2. session topicsand learn sessions on 3. participationhealthy eating behaviors. Finalize topics,dates and Final Results:locations.32WorkWell NC

APPENDIX D: Sample Letter of Invitation to Serveon the Worksite Wellness CommitteeDate ______________________Dear ______________________,You are invited to serve on the Worksite Wellness Committee. The committee will meet on(insert date, time and location). Please check with your immediate supervisor to confirm thatyour participation and responsibility to the Worksite Wellness Committee is approved and will bereflected in your annual work plan. I am available to explain to your supervisor the nature of thecommittee and general time commitments.The major responsibilities of the Worksite Wellness Committee would include but would not belimited to: communicating the wellness program to employees at our worksite, advocating forpolicies that support health, promoting participation in wellness activities, managing the activitiesand evaluating the impact of the wellness program.If you cannot serve on the Committee at this time, please notify me as soon as possible.Sincerely,(Signature—Supervisor/Manager)WELLNESS COMMITTEE GUIDE 33

APPENDIX E: Worksite Wellness Committee Invitation Poster__________________________________________________________________________________(name of worksite)has a golden opportunity to Work Well.Do YOU want to be aleader in realizing theWorkWell NC goal?Join theWorksite WellnessCommitteeContact __________________________________________________________________________to learn more about the program and the responsibilities of serving on theworksite wellness committee.Contact: ____________________________________________________________________________Email ___________________________________ Phone ___________________________________34WorkWell NC

APPENDIX F: Worksite Wellness Committee MembersWORKSITE WELLNESS COMMITTEE MEMBERSName of Worksite______________________________________________________________________Member Name Supervisor Approval Workplan Revision1.2.3.4.5.6.7.8.9.10.11.12.WELLNESS COMMITTEE GUIDE 35

APPENDIX G: First Meeting—Sample AgendaWELLNESS COMMITTEE MEETINGWorksite Name:_______________________________________________Date:________________________ Time:___________________________AGENDACall meeting to orderIntroductions—Committee MembersShare your name, department, favorite food and one favorite physical activitySign Committee Communication list—name, email address and phone numberOrientation to WorkWell NC Wellness Committee Guide5 Components of a Comprehensive Program (Appendix A)Overview of the WorkWell NC resources available at www.eatsmartmovemorenc.com/Worksites.htmlCommittee NameMission StatementCommittee Chairperson and Program Coordinator SelectionEmployee Communication PlanOverview of Action Plan and SurveysWorksite Wellness Committee Action Plan (Appendix B)Worksite Wellness Committee Action Plan Sample (Appendix C)Employee Interest Survey (Appendix I)Policy and Environment Survey (Appendix J)Schedule Future MeetingsAdjourn36WorkWell NC

APPENDIX H: Sample Mission StatementsSAMPLE MISSION STATEMENTSThe mission statement should be a global expression of what the Worksite Wellness Committee wants toaccomplish. The mission statement may include a description of the value of the program to the worksiteand to its employees. You may decide on a mission statement that reflects the work the committee wants toaccomplish. You may choose to select one from these or create your own.Examples:“ The mission of the (name of worksite) Worksite Wellness Committee is to establish andmaintain a worksite that encourages environmental and social support for a healthylifestyle.”“ To encourage employees’ personal and professional productivity, and physical and mentalwell-being, the mission of the (name of worksite) Worksite Wellness Committee shall be topromote a worksite culture that supports employees’ desire to make healthy lifestyle choices.”“ Because employees spend 40 hours a week at work, it is important that the worksite be ahealthy place to work and support healthy choices for employees. It is the mission of the(name of worksite) Worksite Wellness Committee to work toward implementing policies thatsupport a healthy worksite and healthy employees.”“ The worksite wellness committee will work to provide opportunities for employees to develophealthier lifestyles by supporting the adoption of habits and attitudes that contribute to theirpositive well-being.”WELLNESS COMMITTEE GUIDE 37

APPENDIX I: Employee Interest Survey, page 1Employee InterestSurveyDirections: Indicate your interest for each of the following by circling:1: little or no interest 2: some interest 3: very interestedI am interested in:1. learning more about healthy food choices. 1 2 32. learning how to incorporate fruits and vegetables into my diet. 1 2 33. learning about healthier food choices and portions to help manage 1 2 3my weight.4. participating in “tasting” events to sample healthy foods. 1 2 35. having healthy snacks available for purchase at work. 1 2 36. learning more about the benefits of physical activity 1 2 3and how it can influence my health.7. increasing my physical activity level. 1 2 38. walking to increase physical activity. 1 2 39. participating in team activities. 1 2 310. learning ways to cope with feelings of stress. 1 2 311. time management skills. 1 2 312. improving my communication skills. 1 2 313. learning skills to cope with change. 1 2 314. organized social events with my co-workers. 1 2 3Events might be holiday party or summer picnic.15. participating in wellness activities within my regular work schedule. 1 2 316. participating in wellness activities before work 1 2 317. participating in wellness activities after work. 1 2 318. 10-15 minute activities that I can do two to three times a day. 1 2 319. activities that last 30–60 minutes. 1 2 320. health information that I can read, listen to, or watch 1 2 3on my own.21. participating with a group to learn more about wellness. 1 2 3Continued38WorkWell NC

APPENDIX I: Employee Interest Survey, page 2Directions: Indicate your interest for each of the following by circling:1: little or no interest 2: some interest 3: very interestedI am interested in:22. working in a tobacco-free environment. 1 2 323. working with others to reduce second-hand smoke 1 2 3in my workplace.Please complete questions 24–27 only if you currently use tobacco.24. getting information about quitting tobacco use. 1 2 325. attending information sessions or classes about quitting 1 2 3tobacco use.26. using my meal break time to learn about quitting the use 1 2 3of tobacco.27. using time before or after work to learn about quitting the 1 2 3use of tobacco.Please return this survey to: ___________________________________________By this date: ___________________________________________WELLNESS COMMITTEE GUIDE 39

APPENDIX J: Policy and Environment Survey, page 1Policy & EnvironmentSurveyDirections:• This survey is completed by the worksite wellness committee members only.• Please circle your answer to each of the questions.• Choose N/A on any question that does not apply to your worksite.1. Does your worksite have any written policy or policies recommending Yes No Not Sure N/Athe use of healthier foods for holiday celebrations or staff meetings?2. If Yes, are employees told about the healthy foods policy or policies Yes No Not Sure N/Aduring orientation?3. Does your worksite have a refrigerator designated for food for Yes No Not Sure N/Aemployees to use?4. Does your worksite have any equipment and sink access available Yes No Not Sure N/Afor employees to use to prepare and eat meals?5. Does your worksite have any vending machines? Yes No Not Sure N/A6. If Yes, do the vending machine(s) offer at least 5 healthy choices? Yes No Not Sure N/AHealthy choices include fresh fruits, whole grain chips, or baked chips, etc.7. Does your worksite have a cafeteria? Yes No Not Sure N/A8. If Yes, Does your cafeteria offer at least 5 healthy choices like 100% Yes No Not Sure N/Ajuice products, fresh fruits, or whole grain products?9. Has information on healthy food choices been provided to employees Yes No Not Sure N/Ain the past year?How? _________________________________________________10. Does your worksite have any written policy or policies encouraging Yes No Not Sure N/Aphysical activity during the workday?11. Does your worksite have stairs? Yes No Not Sure N/A12. If yes, are the stairs safe, clean and well-lit? Yes No Not Sure N/A13. Does your worksite have a safe place for walking or other activities Yes No Not Sure N/Aon-site or near-by?Name of near-by facility14. Does your worksite sponsor any physical activities, teams or clubs? Yes No Not Sure N/AName of activity: ______________________________________15. Does your worksite sponsor any community-based activities, teams Yes No Not Sure N/Aor clubs?Name of activity: ______________________________________Continued40WorkWell NC

APPENDIX J: Policy and Environment Survey, page 216. Has information on physical activity been provided to employees Yes No Not Sure N/Ain the past year?How provided? ________________________________________17. Does your worksite have any written policy or policies supporting Yes No Not Sure N/Aand encouraging communication that is open, two-way and respectfulof employee diversity?18. Does your worksite have any place for employees to reduce the Yes No Not Sure N/Aphysical and mental stress of the workday?19. Has any activity or activities been provided for dealing with Yes No Not Sure N/Asignificant changes in the worksite in the past 2 years? A significantchange may be a change in management, high staff turnover or loss,or changes in work conditions?What was done? _______________________________________20. Has any program(s) or material(s) for managing stress been provided Yes No Not Sure N/Aat your worksite in the past year? This might be a class for supervisors,relaxation, communication, or time management.What was provided? _ __________________________________21. Does your worksite have any written policy or policies that prohibit Yes No Not Sure N/Aor restrict smoking at the worksite?21a. If Yes, is smoking permitted outside on worksite grounds? Yes No Not Sure N/A21b. If Yes, is smoking permitted anywhere in worksite buildings? Yes No Not Sure N/A22. If Yes to 21 a or b, are signs posted for smoking or non-smoking areas? Yes No Not Sure N/A23. Are tobacco vending machines or vendors restricted or prohibited Yes No Not Sure N/Aat the worksite?24. Has any information on health effects of tobacco been provided to Yes No Not Sure N/Aemployees in the past year?How? _________________________________________________25. Have smoking or tobacco cessation programs been offered on-site Yes No Not Sure N/Aduring the last year?What? ________________________________________________Please return this survey to: ________________________________________By this date: ________________________________________WELLNESS COMMITTEE GUIDE 41

Appendix K: A Guide to Making Physical Activity a Part of Meetings,Conferences and Events, page 1Move More North Carolina:A guide to making physical activitya part of meetings, conferences and eventsMoving more means getting physical activity whereverwe spend our time. In general, the more physical activitywe do the more benefits we get. Even short amounts—10 minutes or more—offer benefits. A great wayto make it easy to move more is to makephysical activity a part of meetings, conferencesand events. Providing an opportunity forpeople to get up and move around helps themre-focus and re-energize after sitting for longperiods of time.Use this guide to make physical activitya part of your next event. It does notmatter if the event is one hour orthree days, everyone will benefitfrom the chance to move more.242WorkWell NC

Appendix K: A Guide to Making Physical Activity a Part of Meetings,Conferences and Events, page 2PlanningPhysical activity should beplanned like any other partof an event. Consider howand when to offer physicalactivity, and what resources,if any, you will need.Physical activity should alsobe included on the agendaand in event materials sothat participants can beready to participate.One-hour to One-dayEventsWhen planning an event that willlast between one hour and oneday, there are several options formaking physical activity a part ofthe event:• Include short physicalactivity breaks throughoutthe agenda. Provide a stretchbreak, play music and leteveryone dance or do an “activeice breaker” to get everyone upand moving.• Provide time for a walkbreak before or afterlunch. Choose a location thathas access to safe walking routesand have a volunteer lead awalk before or after lunch. Orsuggest a route(s) and encourageeveryone to walk on their own.Multi-day EventsWhen planning a multi-dayevent, it is especially important toinclude opportunities for physicalactivity. Choose a location thathas access to physical activityoptions. For example, safe placesto walk/jog, a fitness/recreationcenter, or places of interest withinsafe walking distance, such asrestaurants, local attractionsor historic sites. If a fitness/recreation center is available, askif it is accessible to individuals ofall abilities.There are many options forproviding physical activity duringa multi-day event:• Organize a group walk.Get a volunteer to lead a groupwalk. Pick a time and place tomeet. Let everyone know theprojected pace and distance ofthe walk.• Offer a group exerciseclass. Work with a local fitnesscenter, which can provide acertified instructor, to provide aclass on-site. Indicate what skilllevel is needed for the class (forexample, beginner, intermediateor advanced).• Provide a free pass to alocal fitness/recreationcenter.• Allow time in the agendafor physical activity. Providetime on the agenda in themorning or late afternoon forphysical activity. Adjust theschedule by starting a little laterfor early morning activity orleave time in the afternoon foractivity before dinner.• Include short physicalactivity breaks throughoutthe agenda. Provide a stretchbreak, play music and leteveryone dance or do an “activeice breaker” to get everyone upand moving.Event MaterialsPromote physical activity optionsin the event materials. Includewhat options are available andwhat participants should bring.For example, if there will be awalk during the day, suggestbringing a comfortable pair ofwalking shoes.3WELLNESS COMMITTEE GUIDE 43

Appendix K: A Guide to Making Physical Activity a Part of Meetings,Conferences and Events, page 3Leading Physical Activity Breaksa physical activity break isa structured, 10-15 minuteactivity during the formalagenda. Keep in mind thatattendees will have differentphysical abilities. the purposeof the break is to give everyonethe chance to move for acouple of minutes. there area few things to consider whenleading a physical activitybreak:• Use inclusive language suchas “Stand up or roll back asyou’re able” to include thosein wheelchairs.• Include upper body motionsthat everyone can do,even if they are sitting in awheelchair.• Encourage people to moveonly in ways they feelcomfortable.• Consider what people arewearing; if they are dressedup in suits, skirts or highheeled shoes, motionsmay need to bemodified.the following sectionprovides ideas for simplephysical activity breaks. tryusing one of these activitiesat your next event to see howeasy it can be to help peoplemove more.Ideas for Physical ActivityBreaksMix and Match MotionsThe following are ideas for physical activity breaks. Mix and matchthe following motions or come up with your own.MOtIOnsBalanceBendBlowBounceBrushBuildBumpCatchChewClapClimbClogCycleDanceShoot a jump shotServe a tennis ballRun through tiresBat a baseballDownhill skiSpike a volleyballFixFloatGoHitHopJumpKickLevitateLiftPaintPinchPirouettePokePopPressPullPushRideRotateRollRunSashayServeShuffleSkateSkiSkipSlideSwing a golf clubThrow a footballJuggle a soccer ballShoot an arrowShoot a hockey puckSwim underwaterField a ground ballDunk a basketballSlipSlitherSpinSwaggerSwimSwingTapThrowTurnWalkWaveWiggleWipeSports for AllCall out the following sports skills and have everyone “do” theactivity:(Adapted from Energizers: Classroom-based Physical Activities.Developed by the Activity Promotion Laboratory, School of Healthand Human Performance, East Carolina University available fromwww.EatSmartMoveMoreNC.com)444WorkWell NC

Appendix K: A Guide to Making Physical Activity a Part of Meetings,Conferences and Events, page 4What Is Your Favorite Activity?Start by acting out a physical activity you enjoy: forexample, swimming. Act like you are swimming, whilesaying, “I enjoy swimming.” The whole group also actslike they are swimming. Then call on someone, “Mary,what physical activity do you enjoy?”and Mary replies by saying and actingout her favorite activity. For example,“My favorite activity is canoeing,”and she acts as if she is canoeing. Thewhole group acts as if they are canoeing.Everyone should continue with thecurrent activity until the next activityis called out, then they switch to thenew activity. This continues untileveryone has had a chance to sharean activity. If the group is small,you may want to go around twotimes. Encourage the group to becreative and have fun!Name GameAsk each person to think of a verb, an action, whichstarts with the same letter as their first name, forexample, “Jumping James.” The person does theaction and calls out their action-name. Everyone thenrepeats the action and the action-name. Continue untileveryone has a chance to say their name. If there is timeor if the group is small, go around again. If someonesays “I can’t think of anything,” say “Keep thinking,we’ll come back to you.” If they still don’t come up withanything, ask the group to help.(From http://wilderdom.com/games/descriptions/NamePantomime.html)Dance FeverCall out a type of dance or dance move and haveeveryone do the move. Do each move for 1-3 minutesbefore calling out the next one. Below are someexamples:• The swim• The twist• The hand jive• Staying aliveAsk the group to call out favorite dances whileeveryone does it. If participants cannot stand, all of themoves can be done seated.Dance the Night AwayLead the group througha popular group dancesong. Use a song thegroup would enjoy.• Macarena• Electric Slide• YMCA• The Twist• Achy Breaky HeartAdopt a policy• Twist and Shout• Boot Scoot Boogie• Cha Cha SlideInvisible Beach VolleyballPass out invisible beach balls. Pass (carefully hit) themaround the room. Play along. You may want to makea show of bringing the invisible balls into the room.“Hand” them out to get them started. Encourageparticipants to “hit” the balls in a variety of ways, forexample, with one hand, with two hands, spike, getdown low, to the side, in front, etc. Encourage everyoneto have fun!Leader note: You can use other imaginary games suchas soccer, basketball or tennis.ResourcesMaking physical activity a part of meetings, conferencesand events is a great way to keep everyone engaged,focused and energized. Use your creativity andimagination to get people up and moving.Check out more resources to support eating smartand moving more at: www.EatSmartMoveMoreNC.com.Make a commitment to providing physical activityduring meetings, conferences and events. Adopt apolicy to show your support of helping people movemore. An example of a model policy is provided on theinside back cover of this guide.WELLNESS COMMITTEE GUIDE 5 45

Appendix K: A Guide to Making Physical Activity a Part of Meetings,Conferences and Events, page 5SaMPle ageNda6:30–7:00 a.m. Physical ActivityOption 1: Walk or jog on your own—maps of local routes areavailable at the front desk.Option 2: Group walk—a group will meet in the Lobby at 6:30 a.m.Marie Smith will lead a 30-minute, self-paced walk.Option 3: Group exercise class—Yoga: start your day with somebasic Yoga moves led by certified instructor Rob Miller. The class isdesigned for all skill levels from beginner to advanced. The class willmeet in room B. Please bring a towel and water bottle.7:30–8:30 a.m. Breakfast8:30–10:00 a.m. Session I10:00–10:15 a.m. Break10:15–11:15 a.m. Session II11:15–11:30 a.m. Move More Physical Activity Break11:30–12:15 p.m. Session III12:15–1:15 p.m. Lunch1:15–2:20 p.m. Session IV2:20–2:30 p.m. Break2:30–3:30 p.m. Session V3:30–3:40 p.m. Stretch Break3:40–4:30 p.m. Session VI4:30 p.m. AdjournNote: There is a .25-mile walking route in the garden next to thehotel. Feel free to stroll through and enjoy the scenery before theafternoon session.Enjoy the following physical activity options on your own thisevening:• Fitness Center• A walk through historic downtown• A walk/jog along the local greenway466WorkWell NC

Appendix K: A Guide to Making Physical Activity a Part of Meetings,Conferences and Events, page 6Move More North Carolina Sample Physical Activity Breaks PolicyFor use in any organization, agency or community group that holds meetings, conferences orother events.Whereas:____________________________________________________________(fill in your organization name here)is concerned about the health of its ________________________________________________ (members);Whereas:People are interested in eating smart and moving more;Whereas:Heart disease, cancer and stroke—the top three causes of death in North Carolina—are largelyaffected by what we eat and how physically active we are;Whereas:Physical activity is associated with many positive health benefits and can prevent or delay theonset of many chronic diseases and short amounts, of 10 minutes or more, can contribute to thesebenefits;Therefore:Effective _________________________________________(today’s date), it is the policy of_____________________________________________________________(fill in your organization’sname) that all meetings and events (examples of events may include: meetings, conferences, summits,symposiums, etc.) sponsored or supported by this organization will always include opportunitiesfor physical activity by:• Providing 10-minute physical activity breaks during the scheduled event.• Providing time before and/or after the event for physical activity and adjusting theschedule when necessary.• Choosing venues that offer physical activity opportunities for participants.• Providing encouragement from group leadership for physical activity.___________________________________________________________________________________________SignatureTitle___________________________________________________________________________________________Name of Organization__________________________________DateWELLNESS COMMITTEE GUIDE 47

APPENDIX L: Committee Members and Role SharingCOMMITTEE MEMBERS AND ROLE SHARINGWorksite Wellness Committees can operate efficiently and avoid burn-out if members of the committeeshare responsibilities. Some of the roles that can be shared on a worksite wellness committee include:Committee Chairperson: This position can be shared by two employees as co-chairpersons. Theduties and responsibilities for one may be to handle the administration and communication needs of thecommittee. The other co-chair might be responsible for the overall program activities of the committee.Program Coordinator(s): The number ofprogram coordinators that the committee hasis usually dictated by the number of programsand/or activities that are outlined in the actionplan. By assigning a program coordinatorto each activity that you implement at yourworksite, you do not place the burden of allprograms on one employee.The important thing to remember is to share theresponsibility among committee members andrecruit employees who are not on the committeeas well to serve on sub-committees. Otherchairpersons that can be assigned and sharedinclude:Communications ChairEmployee Interest Survey ChairEvent Planner ChairManagement Liaison ChairAction Plan Chair48WorkWell NC

APPENDIX M: Employee Interest Survey Distribution andCollection SuggestionsIdeas for Distributing Employee Interest SurveysDistributionMethodPersonalDistributionPros Cons Additional InformationLow cost. Personalcontact with employeesmight increase thenumber of surveyresponses. Personalinteraction will allowwellness members to talkabout the importance ofcompleting the EmployeeInterest Survey.Could involve a significant time involvementfor large worksites. In facilities with differentshifts of employee work-time, committeemembers would need to cover all shifts toensure distribution to all employees. Homebasedemployees might not receive surveys.Employees might be disbursed throughoutseveral worksites. Could involve a high levelof committee involvement in counting andmonitoring survey responses in large offices.Personal distribution could be combined withmailbox, paycheck stuffers, or email distributionto include employees at all shifts and locations(this would involve significant committeeinvolvement in identifying employees whoare home-based or work night-time shifts). Insmaller offices, surveys could be distributed andcompleted in staff meetings, ensuring high levelsof survey responses.MailboxstuffersLow cost. Surveys can bedistributed with relativeease.Some employees might not check theirmailboxes. Could involve making high numbersof copies in large offices. Could involve a highlevel of committee involvement in counting andmonitoring survey responses in large offices.Be sure to specify a specific survey collectionspot for employees to drop surveys.Paycheckstuffers,MemoaddendumsLow cost. Surveys can bedistributed with relativeease. Most employeeswill receive (and open)paychecks and employeememos.Could involve making high numbers of copiesin large offices. Method does not includetemporary staff. Could involve a high levelof committee involvement in counting andmonitoring survey responses in large offices.Be sure to specify a specific survey collectionspot for employees to drop surveys.EmaildistributionNo cost. Surveys can bedistributed very easily.Employees might not respond to email. Methoddoes not include employees without email.Could involve a high level of committeeinvolvement in counting and monitoring surveyresponses in large offices.Email distribution could be combined withmailbox stuffers or paycheck stuffers to includetemporary and non-email staff(this would involve significant committeeinvolvement in identifying employeeswithout computers).OnlineSurveysSurveys could beeasily distributed viaemail. Low level ofcommittee involvementneeded in tabulatingsurvey results— thesurvey website willcollect and score data.Very easy to monitorthe number of surveyresponses.Significant cost involved. Method does notinclude employees without internet access.Committee involvement needed in setting upsurvey online.Email notification of online survey site could becombined with mailbox stuffersor paycheck stuffers to include employeeswithout access to the internet (this would involvesignificant committee involvement in identifyingemployees without computers). The followingwebsites offer online surveys:www.zommerang.comwww.surveymonkey.com**Some things to keep in mind while distributing surveys:1. Your wellness committee should consider setting a target date for receiving survey responses. Having a set date to return surveys will make someemployees more likely to complete them.2. Consider having a drawing or incentives for employees who complete their surveys. These incentives or drawings do not have to cost money! Forexample, your committee could: offer relief from shared office tasks (like cleaning common areas or contributing to the coffee fund) to the first 5employees who finish their surveys; find a local business to donate a gift card to give to drawing winners; post a “thank you” note to employeeswho complete their surveys in a visible notice board. (This could be done a week or a few days before the final collection date to remind others tocomplete their surveys.)3. Think about posting fliers or sending out reminder emails to keep employees informed about the importance of the Employee Interest Survey.Remember: a few well placed fliers and a small number of emails will keep people’s attention. Try not to flood employees’ mailboxes with toomany emails or they will begin to delete them.4. Remind Wellness Committee members to talk up the surveys! Committee members are your greatest assets and biggest champions. Memberscan make short presentations in management or office staff meetings about the importance of the survey and the final collection date. Also, askthem to talk about the importance of the Employee Interest Survey to their friends and co-workers. News will spread, generating greater surveyparticipation.WELLNESS COMMITTEE GUIDE 49

APPENDIX N: Worksite Wellness Committee AnnouncementATTENTIONIT’S COMING!YourWorksiteWellnessProgramWorkWell NCWorksite Wellness Coordinator______________________________________________________________________________________Worksite Wellness Committee Members________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________50WorkWell NC

APPENDIX O: Cover Letter for Employee Interest SurveyDear Co-Workers,In today’s fast paced world where most of our lifestyle choices are influenced by convenience andtechnology, chronic health conditions/diseases have begun to rise at an alarming rate.Also, most of the focus and expense of the healthcare industry has been for the treatment ofchronic diseases. By focusing on prevention, several chronic diseases can be prevented or madeless serious. Our employers can play a crucial role in helping us make healthier lifestyle choicesthat can lead to a more enjoyable life for all of us.A worksite wellness committee has been established to make our worksite a healthier workplaceand promote the health of our employees.However, before the wellness committee can initiate wellness activities/programs at the worksite,it is imperative to learn about the interests of our employees. The success of any worksite wellnessinitiative will ultimately depend on what the employees want and will participate in. Pleasecomplete the attached Employee Interest Survey and return to the committee member specifiedbelow.Return your completed survey to ______________________________________ by ___________________.Thank you!Worksite Wellness Committee______________________________________________________________(name of worksite)WELLNESS COMMITTEE GUIDE 51

APPENDIX P: Second Meeting—Sample AgendaWELLNESS COMMITTEE MEETINGWorksite Name: ______________________________________________Date: _______________________ Time: __________________________AGENDACall meeting to orderOld BusinessEmployee Interest SurveyEstablish plan for distribution and collection of surveysWorksite Policy and Environment Survey ReportReport the results of the surveyEstablish long-term goals (strategies and steps) for policy and/orenvironmental changes at the worksiteSelect resources from eatsmartmovemorenc.com/Worksites.htmlManagement IssuesFunding for incentives and materialsWorksite policies regarding wellness activitiesStrategies for Communicating with ManagementReview Schedule of Future MeetingsAdjourn52WorkWell NC

APPENDIX Q: Score Sheet for Employee Interest Survey, page 1EmployEE IntErEst survEy scorE shEEtName of Worksite _____________________________________________Total Number of Surveys Distributed ________________Total Number of Surveys Returned _________________Directions1. Collect all completed Employee Interest Surveys.2. For each question, add the response number that has been circled on all surveys. This will give you thefinal score for each one of the questions from 1 to 27.3. For example, if you collect 3 completed surveys and the responses for Question 1 on these surveys are:3, 2 and 3, then the score for Question 1 is 3+2+3 = 8.EAT SMART1. I am interested in learning more about healthy food choices.2. I am interested in learning how to incorporate fruits and vegetables into my diet.3. I am interested in learning about healthier food choices and portions to helpmanage my weight.4. I am interested in participating in “tasting” events to sample healthy foods.5. I am interested in having healthy snacks available for purchase at work.MOVE MORE6. I am interested in learning more about the benefits of physical activity.7. I am interested in increasing my physical activity level.8. I am interested in walking to increase physical activity.9. I am interested in participating in team activities.MANAGE STRESS10. I am interested in learning ways to cope with feelings of stress.11. I am interested in time management skills.12. I am interested in improving my communication skills.13. I am interested in learning skills to cope with change.14. I am interested in organized social events with my co-workers.Events might be holiday party or summer picnic.WHEN EMPLOYEES WOULD MOST LIKELY PARTICIPATE IN PROGRAMS15. I am interested in participating in wellness activities within my regular work schedule.16. I am interested in participating in wellness activities before work.17. I am interested in participating in wellness activities after work.WELLNESS COMMITTEE GUIDE 53

APPENDIX Q: Score Sheet for Employee Interest Survey, page 2HOW LONG EMPLOYEES WANT PROGRAMS TO LAST.18. I am interested in 10-15 minute activities that I can do two to three times a day.19. I am interested in activities that last 30-60 minutes.INDIVIDUAL OR GROUP ACTIVITIES20. I am interested in health information that I can read, listen to, or watch on my own.21. I am interested in participating with a group to learn more about wellness.SMOKEFREE WORKPLACE22. I am interested in working in a tobacco-free environment.23. I am interested in working with others to reduce second-hand smokein my workplace.QUIT NOWTobacco Users. How many surveys had these questions completed?24. I am interested in getting information about quitting tobacco use.25. I am interested in attending information sessions or classes about quittingtobacco use.26. I am interested in using my meal break time to learn about quitting the use of tobacco.27. I am interested in using time before work or after work to learn about quittingthe use of tobacco.High scores indicate higher employee interest in that particular area. Suggestions and readyto-useresources for individual and group activities in each of the four areas are provided atwww.eatsmartmovemorenc.com/Worksites.html.54WorkWell NC

APPENDIX R: Score Sheet for Policy & Environment SurveyScore Sheet for Policyand environment SurveyName of Worksite _______________________________Number of Completed Surveys ____________________Count the total number of “NO” answers for questions 1–9for all surveys completed by the committee members.This is the EAT SMART score Out of possible score = 9Count the total number of “NO” answers for questions 10–15for all surveys completed by the committee members.This is the MOVE MORE score Out of possible score = 6Count the total number of “NO” answers for questions 16–19for all surveys completed by the committee members.This is the MANAGE STRESS score Out of possible score = 4Count the total number of “NO” answers for questions 20–24for all surveys completed by the committee members.This is the QUIT NOW score Out of possible score = 5Look at the scores for all the four policy/environmental areas. High numbers indicate areas where policyand environmental changes are needed the most to make your workplace a healthier one.Suggestions and ready-to-use resources for worksite policy and environmental changes in each of the fourareas are provided at www.eatsmartmovemorenc.com/Worksites.html.WELLNESS COMMITTEE GUIDE 55

APPENDIX S: Employee Evaluation of a Worksite ActivityEMPLOYEE EVALUATIONOF A WORKSITE ACTIVITYYou recently participated in __________________________________________, a Worksite WellnessProgram activity provided by the Wellness Committee at your worksite.Please complete this evaluation form in order to help the Wellness Committee create the best possiblewellness programs/activities at our worksite. Thank You!Please indicate your level of agreement using this scale:1=Strongly disagree 2= Disagree 3=Agree 4=Strongly agree NS=not sure1. This activity has influenced me to make healthier lifestyle choices. 1 2 3 4 NS2. I would like to participate in similar activities in the future. 1 2 3 4 NS3. I would recommend this activity to my co-workers. 1 2 3 4 NSThe best/most helpful part of this activity was _______________________________________________________________________________________________________________________________________This activity could be improved by: _______________________________________________________________________________________________________________________________________________4. Please check any areas that you would like for wellness programs to be provided:Healthy EatingQuit Tobacco UsePhysical ActivityStress ManagementPlease return this form to:__________________________________________________________________________56WorkWell NC

APPENDIX T: Employee Satisfactionwith Worksite Wellness ProgramEMPLOYEE SATISFACTIONWITH WORKSITE WELLNESS PROGRAMName of Worksite: _____________________________________________ Date: __________________1. Are you aware of the Worksite Wellness Program that has been Yes Noestablished at your worksite?2. Are you interested in receiving additional information concerning Yes Nothe Worksite Wellness Program?3. Have you participated in any wellness activity(ies) conducted at your worksite? Yes No4a. Have you made healthier lifestyle choices since the Worksite Wellness Program Yes Nowas established at your worksite?4b. If Yes, check areas where you have made healthier lifestyle choices (check all that apply).Eating healthierIncreased physical activityQuit tobacco useReduced stress level5. Would you like to participate in future wellness activities at your worksite? Yes No6. What improvements to the Worksite Wellness Program would you like to see?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Your input helps us make improvements to your Worksite Wellness Program. By completing this survey,you help us to provide the best wellness programming and activities at our worksite. Thank you!Please return to (contact person for Worksite Wellness Program):____________________________________________________________________________________________Return by (date): _______________________________If you would like information from the Wellness Committee at your worksite, either contact the personnamed above, or enter your name and contact information below.____________________________________________________________________________________________WELLNESS COMMITTEE GUIDE 57

APPENDIX U: Employee Satisfaction Survey Results FormEMPLOYEE SATISFACTION SURVEYRESULTS FORMName of Worksite: _______________________________________________Report Prepared by: ______________________________________________Number of Surveys distributed:Number of Surveys returned:______________________Percent (%) of employees aware of the worksite wellness programPercent (%) of employees aware of the worksite wellness committeePercent (%) of employees who participated in worksite wellness activitiesPercent (%) of employees who reported lifestyle changes occurred due toworksite wellness program activitiesPercent (%) of employees who would like to participate in future worksitewellness program activities______________________________________________________________________58WorkWell NC

APPENDIX V: Evaluation of Wellness Committeeby Committee MembersEVALUATIONOF WELLNESS COMMITTEEBY COMMITTEE MEMBERSThis questionnaire is designed to help your committee assess your Worksite Wellness Program and thecommittee’s strengths and weaknesses. It is for your use only to guide your discussions of how well thecommittee functions and how the wellness program could be improved. Feel free to add other questionsthat you think would help this effort.1. Are all areas of your worksite represented on your committee? Yes No1a. How could representation be improved?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2. Is management represented on your committee? Yes No3a. In what ways has management been supportive of your efforts?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________3b. In what ways would you like management to be more supportive?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4. Has the committee completed a written action plan? Yes No4a. Does the action plan include at least one short-term and one Yes Nolong-term objective?4b. Have you implemented any activities from your action plan? Yes No4c. Which behavior(s) does your action plan focus on?Healthy EatingPhysical Activity5. What would help your committee do a better job of working together?Quit Tobacco UseStress Management______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________6. In what ways is the wellness program helping employees?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________7. What could the committee do to make the program more effective?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________WELLNESS COMMITTEE GUIDE 59