WWKS - Foundation Assessment

Foundation Assessment

The worksite wellness “foundation” is the basis upon which a successful comprehensive worksite wellness initiative is predicated. The five worksite wellness foundation components (data, exercising leadership, wellness committee, incentives, and communications) need to be developed and implemented prior to the development and implementation of a worksite wellness initiative.
Your worksite's individual responses to the survey will not be shared with anyone not affiliated with WorkWell KS. This survey will be used as an assessment to provide worksites with information about the steps your worksite can take to establish a worksite wellness initiative. Only aggregated results (with no worksite identifiers) may be published. If you have any questions regarding this survey, please contact Dr. Elizabeth Ablah at 316-293-2627 (eablah@kumc.edu).
Name of worksite*
Primary contact at worksite*
Contact email*
example@example.com
County*
Zip*
City*
Phone Number*
Please enter a valid phone number.
Approximate number of employees
Not counting temporary or seasonal
Approximate number of employee dependents
Spouses and children
What industry type best describes your worksite?

Agriculture, Forestry, Fishing, and HuntingMining, Quarrying and Oil and Gas ExtractionUtilitiesConstructionManufacturingMachinery, Equipment, and Supplies Merchant WholesalersRetail TradeTransportation and WarehousingInformationFinance and InsuranceReal Estate, Rental, and LeasingProfessional, Scientific, and Technical ServicesEducational ServicesHealthcare and Social AssistanceArts, Entertainment, and RecreationAccommodation and Food ServicesGrant Making and Civic OrganizationsPublic Administration (including health departments)Other
Data

Does your worksite use any of the following data to guide your worksite wellness initiative?*

	Yes	No
Health risk assessment
Biometrics
Employee needs or interests
Medical claims/costs
Absenteeism
Presenteeism
Environmental/Cultural Audit
Productivity
Feedback on already offered initiatives
We have not yet started any worksite wellness programs/activities

Does your worksite evaluate your wellness programs/activities (e.g., track participation rates, compare outcomes to pre-determined objectives/goals)?*

YesNoN/A (we have not yet offered any programs/activities)
D1:Value Scale - total
D1:Calc #NA Questions
D1:Calc:Score
D1:Calc Scale Adjusted
D1:Calc:ScoreRounded
D1:Calc Percent
Exercising Leadership
Does your worksite's organizational mission statement contain references to improving/maintaining employee health OR has your wellness committee adopted a health-related mission statement?*

YesNoI don't know

Generally, does your worksite wellness initiative have support (such as leading by example and/or encouraging involvement in healthy activities) from:*

	Yes	No
Executives/upper management?
Middle management?

L1:Value Scale - total
L1:Calc:Score
L1:Calc Percent
Wellness Committee
Does your worksite have a wellness committee?*

YesNo
Does your worksite wellness initiative have a budget?*

YesNo
Do each of the worksite wellness committee members have these job duties included in their position description?*

YesNo
Which response best reflects the composition of your worksite wellness committee?*

The wellness committee is comprised of staff who volunteered to serveThe wellness committee is comprised of staff were assigned to serveThe wellness committee is comprised of a mixture of volunteers and assigned staff

Does the wellness committee have the capacity to improve health at the worksite?*

YesNo

Does your wellness committee meet at least quarterly?*

YesNo
Does your worksite have at least one staff member responsible for coordinating wellness?*

YesNo
Is this person located onsite?*

YesNo
Does this person have worksite wellness duties included in his/her job description?*

YesNo
W1:Value Scale - total
W1:Calc:Score
W1:Calc Percent
Communication
Has your workplace started a wellness initiative yet?*

YesNo
Are regular communications provided to employees during all phases (assessment, planning, implementation, and evaluation) of your worksite wellness initiative?*

YesNo
Does your worksite wellness initiative use marketing strategies to promote consistent information through multiple delivery channels (e.g., written, oral, and electronic)?*

YesNo
Are your communications materials appropriately tailored/customized to your employees?*

YesNo
C1:Value Scale - total
C1:Calc:Score
C1:Calc Percent
Incentives

To support wellness participation or adherence, has your worksite identified a range of:*

	Yes	No
Non-financial (e.g., recognition, jeans day) incentives
Financial (e.g., merchandise, cash, time off, medical savings account) incentives

I1:Value Scale - total
I1:Calc:Score
I1:Calc Percent
Should be Empty:

	Yes	No
Departments
Levels of management
Levels of interest in wellness

	Yes, already engaged	No, working to get engaged	No
Senior management
Middle management
Frontline staff

	Yes	No
Goals for worksite wellness?
Objectives for worksite wellness?

Foundation Assessment

Data

Exercising Leadership

Wellness Committee

Communication

Incentives