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2. Gender

   1. Male
   2. Female
4. Age Demographics

   1. 18-24
   2. 25-34
   3. 35-49
   4. 50-59
   5. 60 and above
6. When you are at work, which of the following best describes what you do?

   1. Mostly sitting and standing
   2. Mostly walking
   3. Mostly heavy labor or physically demanding work
   4. Mostly driving a motor vehicle
   5. Mostly operating heavy equipment
8. I find the following program(s) helpful and would like for them to remain in place (Check all that apply)

   1. Biometric screening
   2. Flu shot
   3. Employee Wellness Committee events
10. What department do you work in?

    1. Community Development
    2. Village Administration
    3. Engineering and Public Works
    4. Finance

    1. Police Department
    2. Library
    3. Park District Administration
    4. Park District Recreation
12. What is your employment classification

    1. Full-time
    2. Part-time
14. Are you familiar with?: (Check all that apply.)

    1. Employee Assistance Program
    2. BCBS Nurseline
    3. BCBS Well onTarget℠ Program
    4. BCBS Life Points
    5. BCBS Fitness Program
    6. Employee Discounts at the Sachs Center
    7. Employee Wellness Committee
16. How likely are you to participate in a wellness/health promotion program at work?

    1. Very likely
    2. Somewhat likely
    3. Not likely
18. If not likely, why?
20. How long should a wellness/health promotion activity last?

    1. Less than 30 minutes
    2. 30-45 minutes
    3. 45-60 minutes
    4. More than 60 minutes
22. There are many ways to disseminate health information at the worksite. What communication method(s) do you prefer? Check all that apply

    1. Posters/flyers
    2. E-mail
    3. Handouts/brochures
    4. Other
24. If other, please specify
26. What time of day would be best for you to participate in a wellness/health promotion activity?

    1. 7 a.m. - 8 a.m.
    2. 11 a.m. - noon
    3. Noon - 1 p.m.
    4. After work at 3:30 p.m.
    5. After work at 4:40 p.m.
    6. Weekend activities
    7. Would not participate
28. Which topic would you like to see in a wellness/health promotion program? Check all that apply.

    1. Aging
    2. Alternative medicine
    3. Back care
    4. Cancer awareness
    5. Career coaching
    6. Dealing with menopause
    7. Office ergonomics
    8. Financial management
    9. Mental health

    1. Nutrition
    2. Parenting
    3. Physical activity
    4. Prenatal
    5. Safety (CPR/First Aid)
    6. Stress management
    7. Tobacco cessation
    8. Women's/Men's health
    9. Work relations
30. What other topics or activities would you like to see offered in a wellness/health promotion program?
32. Incentives are gifts or prizes to motivate participation in programs at work. How do you feel about incentives?

    1. I would only participate if there was an incentive
    2. I would participate without an incentive
    3. I wouldn't participate either way
34. Which incentives would motivate you the most? (Pick three)

    1. Gift certificates
    2. Free food
    3. Recognition
    4. Fitness memberships
    5. Gifts (t-shirt, electronics, fitness equipment)
    6. Cash
36. Would you be willing to pay a nominal fee for some wellness/health promotion activities?

    1. Yes
    2. No
38. If yes, how much?
40. My employer provides opportunities for me to be physically active?

    1. Yes
    2. No
42. Are there any aspects of your work environment that should be changed to be more supportive of a healthy lifestyle?

    1. Yes
    2. No
44. If yes, please explain.
46. Do you feel your health, safety and well-being is an important priority for management?

    1. Yes
    2. No
48. If no, why not?
50. I feel that Deerfield is a place where employees take pride in their work and have a great deal of togetherness.

    1. Agree
    2. Disagree
    3. Other
52. If other, please specify.
54. What might prevent you from participating in a wellness/health promotion program? (Check all that apply)

    1. Lack of time
    2. Lake of motivation
    3. Lack of interest
    4. Lack of funds
    5. Poor past experience
    6. Privacy concerns
    7. I don't need it
    8. Other
56. If other, please specify.
58. If Deerfield offered an incentive that paid entrance fees for you to participate in charity walks, 5k or 10k walks/runs, and marathons, would you take advantage and participate?

    1. Yes
    2. Maybe
    3. No
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