WIC Worksite Wellness Program Commitment

WIC Worksite Wellness

Program Commitment Form
I first & last name, on behalf of agency name recognize the value of our Local Agency and its offices becoming a Certified Well WIC Worksite. Our Agency will follow the “Ten Steps” guidelines and criteria to make health and wellness a part of the Agency’s work culture. Our Agency will actively support employees in activities that foster and maintain all-around health and create a health-promoting environment. We promise to use imagination to propose healthful activities, solicit ideas from our staff, and encourage a dialogue that will promote well-being among all staff. I further promise to create and work toward my own set of wellness goals and to support my fellow employees as they work toward their own goals. I understand that our agency has 18 months to become a Certified Well WIC from when we initiate this commitment form.
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Name

First NameLast Name
Agency Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Congratulations on taking the first step toward becoming a Certified Well WIC Worksite!
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WIC Worksite Wellness