Culture of Wellness Award Application
General Information Questions
Name of Company
*
Location (City, State) of Company Headquarters
*
Primary Contact Name
*
Contact Email
*
example@example.com
Contact Phone
Please enter a valid phone number.
Name of person completing application (if different from primary contact)
Email of person completing application (if different from primary contact)
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Section 1: Leadership Commitment
Describe senior leadership involvement and support
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Section 2: Culture, Foundation and Policies
How do you embed wellbeing in your company culture?
How long has your program been in place and/or describe its evolution
Describe any company policies in place supporting wellbeing.
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Section 3: Program Offerings / Tools / Incentives
Describe the program, including any "pillars" or dimensions of health.
Describe any onsite, telephonic, and/or digital (online) programs.
Describe any rewards for participating/engaging.
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Section 4: Strategic Planning / Communications
What are the program goals and objectives, and/or multi-year strategy?
Describe any branding of wellness program
Describe channels of communication for the program
Describe any components of planning
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Section 5: Reporting Metrics & Evaluation
Describe the timing and metrics used for evaluation of program success
Describe any data reported back to your employee population.
Describe the means of evaluation. How do you measure success?
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Section 6: Organization Engagement Data
What is the engagement level for health risk assessments (if any) as a part of the program?
Describe any correlation with engagement in preventive care visits
Describe any correlation to disease management engagement
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Section 7: Innovation / Technology
Describe any innovative tools or use of technology to meet changing needs of population.
Conclusion
Is there anything else about your culture of wellness you'd like to let us know?
Website / URL of Wellness Program (if available)
If you have any supporting documents you would like to provide, you may upload them here.
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