Corporate Assessment Form

The purpose of the assessment is to allow corp. to recognize what initiatives will positively influence employee health and well-being. It will also help to identify possibilities of a fitness /wellness program within your organization.

The assessment will highlight areas that your corporation may already have well managed and identify other areas that have been underdeveloped.

Physical Considerations

• available fitness facility on-site that is managed by fitness professional ( lockers and showers avail.)
• cafeteria offering healthy food and vending machines stocked with healthy snacks
• ergonomic work areas
• health /wellness promotion within company
• healthy water available
• etc.

Programs and Services

• organized programs staff by professional staff
• fitness programs subsidized
• fitness/health committee including management and employee
• screening programs like blood pressure, cholesterol, etc.
• health education materials/workshops ( i.e.. osteo, heart health, etc)
• nutrition/weight management
• back care
• daily stretch breaks
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Corporate Culture

• does company mission embrace employee health and wellness
• management recognition for participation in programs
• managers acting as role models
• employees encouraged to take advantage of programs and take leadership roles amongst peers

By reviewing these issues both employer and employee can determine where the needs and resources may best applied.

Name of Organization
Address
Phone
Email
Web Address
Corporate Physician
Name
Address
Phone
Health / Wellness Committee Contact
Occupations within the Organization
How do the employees spend the majority of their time?
Travel Sit Stand Lift Other Explain:
Nature of Occupation
Physical   Stressful	Other:
Explain a typical day in the life of an employee within the organization
Does the company have a nutritionist available for employees to consult?
	Yes   No
Does the company have a chiropractor, athletic therapist, massage therapist or physiotherapist available for consultation?
	Yes   No
Gym membership / Facilities within the organization?
	Yes   No
Would the company be interested in having health / fitness seminars presented to employees?
	Yes   No
Would the company be interested in upper level management rewards or special programs?
	Yes   No
What are the primary areas of interest behind the introduction of a health / fitness program for employees back to basics cardiovascular fitness ergonomics facility design facility management fitness for corporate travel fitness/wellness programs group programming - ie: Running Clinic, 1-2-1 Seals Fitness, Pilates massage therapy nutrition education stress release weight training / body sculpting other - please explain
Please list both short and long-term goals of introducing a health / fitness program to the company
Any additional comments?