WELLNESS COMMITTEE GUIDE

WELLNESS

COMMITTEE

GUIDE

WELLNESS

COMMITTEE

GUIDE

I. What Is a Worksite Wellness Program? ................................. 1

II. What Is a Worksite Wellness Committee? ............................. 3

III. Establishing and Maintaining ...................................................... 5

a Worksite Wellness Committee

Step 1. Identifying Committee Members ........................................................... 8

Step 2. First Meeting—Establishing the Committee .......................................10

Step 3. Second Meeting—Obtaining Employee Opinions ..............................14

Step 4. Third Meeting—Developing an Action Plan .......................................18

Step 5. Fourth Meeting—Updating Program Progress .................................... 21

Step 6. Fifth Meeting—Updating and Evaluating Program Progress .............22

Step 7. Year End Meeting—Evaluating Overall Program ..............................24

IV. Appendices ..................................................................................................27

Appendix A: Five Components to a Comprehensive Program ....................28

Appendix B: Wellness Committee Action Plan Template ...........................29

Appendix C: Wellness Committee Action Plan Sample ..............................31

Appendix D: Sample Letter of Invitation to Serve .......................................33

on the Wellness Committee

Appendix E: Wellness Committee Member Invitation Poster .....................34

Appendix F: Wellness Committee Member List .......................................... 35

Appendix G: First Meeting—Sample Agenda ..............................................36

Appendix H: Sample Mission Statements ..................................................... 37

Appendix I: Employee Interest Survey ........................................................ 38

Appendix J: Policy and Environment Survey .............................................. 40

TABLE OF

CONTENTS

TABLE OF CONTENTS, CONTINUED

Appendix K: A Guide to Making Physical Activity

a Part of Meetings .................................................................... 42

Appendix L: Committee Members and Role Sharing Ideas ........................48

Appendix M: Employee Interest Survey Distribution and Collection ..........49

Suggestions

Appendix N: Worksite Wellness Committee Announcement Poster ........... 50

Appendix O: Cover Letter for Employee Interest Survey ............................51

Appendix P: Second Meeting—Sample Agenda .........................................52

Appendix Q: Score Sheet for Employee Interest Survey .............................53

Appendix R: Score Sheet for Policy and Environment Survey....................55

Appendix S: Employee Evaluation of a Worksite Activity .........................56

Appendix T: Employee Satisfaction with Worksite Wellness Program ......57

Appendix U: Employee Satisfaction Survey Results Form .......................... 58

Appendix V: Evaluation of Wellness Committee .........................................59

by Committee Members

SECTION I

What Is a

Wor k site

Wellness

Progr am?

Wellness Committee Guide

2 WorkWell NC

worksite wellness program is an organized

program for employees designed to enrich

their physical, mental, emotional, occupational and

spiritual well-being.

A major goal of the program is to make the work

environment more supportive of positive health

behaviors of employees and thereby reduce their

risk of developing chronic diseases. The concept of

wellness, however, goes beyond reducing disease

and includes promoting and supporting improved

well-being for all employees.

Even healthy employees will welcome the

opportunity to work in an environment that supports

their healthy lifestyle goals. Worksite Wellness

activities can help all employees increase their

energy and reduce stress.

The WorkWell NC Wellness Committee Guide

provides the resources and tools to conduct worksite

wellness programs and activities. These resources

and tools have been designed utilizing the five

components of comprehensive programs outlined

below.

What Is a Worksite

Wellness Progr am?

FIVE COMPONENTS OF COMPREHENSIVE PROGRAMS

1. Health Education

Examples: Health promotion literature,

newsletters, seminars, education sessions such as

lunch-n-learns, classes or lectures, etc.

2. Supportive Social and Physical Environments

Examples: Incentives, walking/running groups,

exercise or fitness classes/groups, facilities

(showers, locker rooms, on-site gyms, etc.)

offered, bike racks or storage, gym memberships,

food services and facilities (cafeterias, vending,

preparation and storage) offered, lactation

support, tobacco-free facilities, etc.

3. Integration of Worksite Program into

Organizational Structure

Examples: Existence of formal health and

wellness policies, dedicated staff and employees

plan programs, management and supervisors are

involved in planning and support implementation,

employee access and program utilization is

encouraged

4. Linkages with Related Programs

(EAP, Safety, etc.)

Examples: Employee assistance, occupational

health and safety programs, health benefits or

flexible spending accounts, flexible/telecommute

schedules, or other programs

5. Screening Programs

Examples: Mental health, blood pressure,

diabetes, substance abuse, mammography, stress,

cholesterol, Health Risk Appraisal, etc.

Key Item to Remember:

As employees’ behaviors change and their

health improves, it is critical that the policies,

practices and physical environment of the

worksite also change to support the individual

health improvements. One cannot achieve

success and sustainability without the other.

SECTION II

What Is

a Wor k site

Wellness

Committee?

Wellness Committee Guide

4 WorkWell NC

THE WORKSITE WELLNESS

COMMITTEE

• is a team of employees who formally meet and plan activities

to promote good health for themselves and for their fellow

workers,

• represents employees from all organizational levels,

• communicates to employees information about known health

risks and the value of a worksite wellness committee and

wellness initiatives,

• creates and maintains open lines of communication

between wellness committees and employees,

• promotes participation in both individual and group

activities,

• advocates for worksite policies and environments that support

improved health,

• coordinates the monitoring and evaluation of

the wellness activities/programs offered to

employees, and

• serves as the leader/champion for wellness

activities at their worksite.

The WorkWell NC Wellness Committee Guide

provides the resources and tools for worksite

wellness committees to establish, maintain

and sustain a successful worksite wellness

program.

What Is a Worksite

Wellness Committee?

Worksite Wellness—

Commitment and Support

Establishing, supporting and maintaining

a worksite wellness committee provides

opportunities for all employees (both management

and staff) to:

• create a healthy worksite;

• foster collaboration and partnerships; and

• establish healthy lines of communication

between support staff, line supervisors, middle

and top management.

SECTION III

Establishing

and Maintaining

a Wor k site

Wellness

Committee

Wellness Committee Guide

6 WorkWell NC

he WorkWell NC Wellness Committee Guide

recommends the following steps to establish a

successful worksite wellness committee and to support

healthy lifestyle behaviors among the worksite

employees.

THE STEPS:

1. Identifying Committee Members and Prepare for

Initial Meeting

2. First Meeting—Establishing the Committee

3. Second Meeting—Obtaining Employee Opinions

4. Third Meeting—Developing an Action Plan

5. Fourth Meeting—Updating Program Progress

6. Fifth Meeting—Updating Program Progress

7. Year End Meeting—Evaluating Committee Activities

Step-by-Step Instructions

April

Identifying

Committee

Members

and Prepare

for Initial

Meeting

May

Establishing

a Worksite

Wellness

Committee

July

Obtaining

Employee

Opinions

Sept

Developing

an Action

Plan

Nov

Updating

Program

Progress

Jan

Updating

Program

Progress

March

Completing

the 12

Month

Evaluation

April

Identifying

Committee

Members,

etc.

Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 1

A Year in the Life of a Worksite Wellness Committee

SAMPLE

Wellness

Committee

Action

Plan

Organization:

ABC Corporation

Program Coordinator:

Sally Jo Smith

Planning Chairperson:

Bruce Morgan

Period Beginning:

January 1, 2011

Period Ending:

December 31, 2011

Vision Statement:

provide a work cultu

re that supports our employees’ health

Goals:

1. Improve access to healthy foods and beverages during the work day

2. Encourage employees to be physically active during the work day

Period Budget:

$500

.00

Overall Marketing and Communications Strategies:

•

Establish a bulletin board for print announcements, flyers and general wellness information.

•

Establish a posted calendar mark the start and end date of all activities.

•

Establish wellness update

s as a standing agenda item for all staff meetings

WELLNESS COMMITTEE GUIDE 7

Worksite Wellness Committee—

Key Items to Remember

• In order to establish an effective worksite wellness committee, the committee members should

plan to complete the steps in the The WorkWell NC Wellness Committee Guide over a twelve-

month period. The proposed steps are flexible and can be altered to accommodate the needs of

your worksite wellness committee.

• There are a minimum of six recommended meetings that should be held within this time period.

This timeline may need to be expanded, for example, to include at least one meeting per month

lasting at least one hour in duration. The number of meetings may depend on survey results and

findings by the worksite wellness committee.

• The Worksite Wellness Committee Action Plan (Appendix B and Appendix C) is critical to

the guidance and success of program activities, the evaluation of those activities and reporting

results to management.

• After the wellness committee has completed the first year, the committee can continue to use

the workbook as a guide for years two, three and so on.

• The committee workbook has been created so that committee members can rotate off and new

employees can rotate onto wellness committees. The committee workbook is an easy to follow

guide for new committee members and helps to ensure sustainability of the worksite wellness

program.

• Worksites that have an established wellness committee can utilize this workbook as a resource

to review their current committee work and are encouraged to use these tools to enhance their

committee work.

• All committees—new or established—can utilize the agendas, surveys, resources and ideas

provided in the toolkit.

8 WorkWell NC

his committee guide is designed so that anyone

at your worksite can begin the process of

establishing a Wellness Committee, but it may be

necessary to allow management to identify initial

committee members.

Identifying committee members can be

accomplished in two ways: by invitation and/or

soliciting volunteers. Consider the following

when identifying people to serve on the wellness

committee:

1. Invite staff members to serve on the wellness

committee. Staff members should be asked, in

person or by letter, about their willingness and

interest to serve. See Appendix D for a sample

committee invitation letter.

2. Solicit volunteers by placing announcements

in high traffic locations, through employee

newsletters, via e-mail, or by other means.

Committee members who volunteer can become

program “champions” encouraging success

for the entire

worksite.

Volunteers have

the potential to

bring increased

energy to the

committee. See

Appendix E

for a sample

committee

recruitment

announcement.

Identifying Committee Members—

Key Items to Remember

• Number of Committee Members—It is

recommended that you have between four

and twelve committee members, although

this number may depend on the size of your

worksite.

• Suggested Committee Members—Include

committee members from all departments

(human resources, information support, etc.).

Also include members of management and

support staff.

• Existing Committees—If you have

existing committees, such as a safety or

social committee, target these members for

invitation.

• Supervisor Approval—All committee

members should have their immediate

supervisor’s support for the time and work

they dedicate to the wellness committee.

• Work Plan Revision—Employees may need

to revise their annual work plan to reflect the

duties of serving on the wellness committee.

__________________________________________________________________________________

(name of worksite)

has a golden opportunity to Work Well.

Join the

Worksite Wellness

Committee

Contact

__________________________________________________________________________

to learn more about the program and the responsibilities of serving on the

worksite wellness committee.

Contact

: ____________________________________________________________________________

___________________________________

Phone

___________________________________

Do YOU want to be a

leader in realizing the

WorkWell NC goal?

Step 1: Identifying Committee

Members and Getting Started

WELLNESS COMMITTEE GUIDE 9

Once committee members have been identified,

be sure to complete the Worksite Wellness

Committee Members’ Form (Appendix F), listing

the committee members’ names with management

approval, and any necessary workplan revision.

Now, Get Started!

Now that committee members have been recruited,

your first goal is to prepare for your first meeting.

This may seem relatively simple, but it is the most

critical part of the process.

• Schedule a date, time, and place that is convenient

for all committee members. Allow one to two

hours for this initial meeting. As you will see

in Step 2, this amount of time is essential in

establishing an effective and organized worksite

wellness committee.

• The individual who recruited initial wellness

committee members may facilitate the first

meeting, where a committee chairperson will be

selected.

• Step 2 of this Committee Guide provides detailed

information about the first meeting in addition to a

sample agenda.

Getting Started—

Key Items to Remember

All items from this Committee Guide and

additional materials to support your Wellness

Committee can be downloaded for free at

www.eatsmartmovemorenc.com/Worksites.html.

WORKSITE WELLNESS COMMITTEE MEMBERS

Name of Worksite _____________________________________________________________________

Member Name Supervisor Approval Workplan Revision

10.

11.

12.

10 WorkWell NC

s a member of management and/or

employee who has been selected to convene

the first meeting of the wellness committee,

you should provide an overview/orientation

to other committee members about the

organization and utilization of the WorkWell NC

Wellness Commitee Guide. This task should be

accomplished in the first committee meeting.

The objectives and detailed points of

discussion for the first meeting are provided

below. A sample agenda for the meeting is also

provided in Appendix G. It can be printed from

www.eatsmartmovemorenc.com/Worksites.html

for distribution during the committee meeting.

You can also modify the objectives and the

agenda to better suit the needs and organization

of your particular worksite.

AGENDA ITEMS

1. Call meeting to order (5 minutes)

The facilitator of the meeting should ask for a volunteer to record

the minutes of the meeting.

2. Introductions—Committee Members (10 minutes)

Each employee introduces himself or herself and shares one

favorite food and one favorite physical activity. (See Appendix K

for additional physical activity breaks.)

Committee Communication: Pass around the Worksite Wellness

Committee Members Form (Appendix F) for members to list their

name.

3. Orientation to the WorkWell NC Wellness Commitee Guide

(20 minutes)

Introduce the WorkWell NC Wellness Commitee Guide to

committee members.

• 5 Components of a Successful Program (Appendix A)

• Introduce committee members to the tools available on the web at:

www.eatsmartmovemorenc.com/Worksites.html.

WELLNESS COMMITTEE MEETING

Worksite Name: __________________________________________________

Date: _________________________ Time: ____________________________

AGENDA

Call meeting to order

Introductions—Committee Members

Share your name, department, favorite food and one favorite physical activity

Sign Committee Communication list—name, email address and phone number

Orientation to Work Well NC Wellness Committee Guide

5 Components of a Comprehensive Program (Appendix A)

Overview of the Work Well NC resources available at eatsmartmovemorenc.com/Worksites.html

Committee Name

Mission Statement

Committee Chairperson and Program Coordinator Selection

Employee Communication Plan

Overview of Action Plan and Surveys

Worksite Wellness Committee Action Plan (Appendix B)

Worksite Wellness Committee Action Plan Sample (Appendix C)

Employee Interest Survey (Appendix I)

Policy and Environment Survey (Appendix J)

Schedule Future Meetings

Adjourn

Step 2: First Meeting—

Establishing the Committee

MEETING OBJECTIVES

• Overview and orientation of worksite wellness

program and toolkit

• Identify worksite wellness committee

chairperson and program coordinator

• Select a name for the committee and write a

mission statement (Appendix H)

• Develop a communication plan to announce

the program/activities to employees

• Introduce the Worksite Wellness Committee

Action Plan (Appendices B and C)

• Introduce Employee Interest Survey

(Appendix I)

• Introduce and distribute Policy &

Environmental Survey to committee members

(Appendix J)

WELLNESS COMMITTEE GUIDE 11

4. Committee Name (10 minutes)

Select a name for the worksite wellness committee.

Name ______________________________________________________

5. Mission Statement (15 minutes)

The mission statement should be a

global expression of what the Worksite

Wellness Committee wants to accomplish.

The mission statement may include a

description of the value of the program

to the worksite and employees. You

may decide on a mission statement that

reflects the work the committee wants to

accomplish. Some examples of mission

statements are given on the right and in

Appendix H. You may choose to select

one from these or create your own.

6. Selection of Committee Chairperson

(10 minutes)

Select the Worksite Wellness Committee

Chairperson. The chairperson is

responsible for conducting the meeting(s)

and handling any administrative paperwork

and reporting for the committee.

Committee Chairperson:

_________________________________

This person will:

• not need a background in health—this

guide is self-directing,

• send committee meeting reminders,

meeting minutes and other details

documenting the wellness committee’s work,

• distribute, collect and score the Policy and Environmental Survey (this

survey is completed by committee members only—Appendix J),

• coordinate employee program activities, with the help of the program

coordinator (see page 12) and,

• submit documents to management for program evaluation such as notes

or minutes from meetings, sample email messages, etc.

Mission Statement Examples

• “The mission of the (name of worksite) Worksite

Wellness Committee is to establish and maintain a

worksite that encourages environmental and social

support for a healthy lifestyle.”

• “To encourage employees’ personal and professional

productivity, and physical and mental well-being, the

mission of the (name of worksite) Worksite Wellness

Committee shall be to promote a worksite culture

that supports employees’ desire to make healthy

lifestyle choices.”

• “Because employees spend 40 hours a week at work,

it is important that the worksite be a healthy place

to work and support healthy choices for employees.

It is the mission of the (name of worksite) Worksite

Wellness Committee to work toward implementing

policies that support a healthy worksite and healthy

employees.”

• “The worksite wellness committee will work to

provide opportunities for employees to develop

healthier lifestyles by supporting the adoption of

habits and attitudes that contribute to their positive

well-being.”

12 WorkWell NC

7. Selection of the Worksite Wellness Program Coordinator. (10 minutes)

The program coordinator (one or more persons for large worksites—

see Appendix L for role sharing ideas) will serve as the overall

coordinator for the program activities.

Program Coordinator(s):

_________________________________________________________

This person will:

• not need a background in health—these resources are self-directing,

• devote time in his or her regular work schedule to address

coordination responsibilities,

• distribute, collect and score the Employee Interest Survey

(Appendix I) which will be distributed to all employees at the

worksite (see Appendix M for methods of distribution, collection and

scoring of surveys), and

• coordinate employee program activities,

with the help of the committee chairperson

and/or other program chairs as assigned.

8. Employee Communication Plan

(10 minutes)

Establish a plan for communicating with

employees that

• announces the formation (or continuation)

of the wellness committee (Appendix N),

• provides information to employees about

upcoming programs and events, and

• provides employees with periodic updates

about the worksite wellness program.

9. Action Plan Template and Sample (5 minutes)

Provide a copy of the Worksite Wellness Committee Action Plan Template

(Appendix B) and Action Plan Sample (Appendix C) for

committee members to review for the next meeting.

10. Employee Interest Survey (10 minutes)

Provide a copy of the Employee Interest Survey (Appendix I)

and the accompanying cover letter (Appendix O) to all committee

members to review before the next meeting.

The results of this survey will help the committee determine the

short-term goals for the Worksite Wellness Committee Action Plan.

Ask that committee members review the survey and think about

how this survey should be distributed to employees at your worksite.

This may be done personally, through email, mailboxes or some

other practical means depending upon the size of your worksite and

the number of employees. (See Appendix M for suggested survey

distribution and collection suggestions.)

Examples of ways to communicate

with employees include:

• Kick-off events

• Announcements

through agency

“intranet” service

• Posters on bulletin

boards, entrance doors

and restroom doors

• Newsletter articles

• Email announcements

• Employee letters

• Payroll stuffers

• Intercom

announcements

• Staff meetings

• Employee celebrations

WORK WELL NC

Employee Interest Survey

Directions: Indicate your interest for each of the following by circling:

1: little or no interest 2: some interest 3: very interested

I am interested in:

1. learning more about healthy food choices. 1 2 3

2. learning how to incorporate fruits and vegetables into my diet. 1 2 3

3. learning about healthier food choices and portions to help manage 1 2 3

my weight.

4. participating in “tasting” events to sample healthy foods. 1 2 3

5. having healthy snacks available for purchase at work. 1 2 3

6. learning more about the benefits of physical activity 1 2 3

and how it can influence my health.

7. increasing my physical activity level. 1 2 3

8. walking to increase physical activity. 1 2 3

9. participating in team activities. 1 2 3

10. learning ways to cope with feelings of stress. 1 2 3

11. time management skills. 1 2 3

12. improving my communication skills. 1 2 3

13. learning skills to cope with change. 1 2 3

14. organized social events with my co-workers. 1 2 3

Events might be holiday party or summer picnic.

15. participating in wellness activities within my regular work schedule. 1 2 3

16. participating in wellness activities before work 1 2 3

17. participating in wellness activities after work. 1 2 3

18. 10-15 minute activities that I can do two to three times a day. 1 2 3

19. activities that last 30–60 minutes. 1 2 3

20. health information that I can read, listen to, or watch 1 2 3

on my own.

21. participating with a group to learn more about wellness. 1 2 3

Continued

Your

Worksite

Wellness

Program

WorkWell NC

Worksite Wellness Coordinator

______________________________________________________________________________________

Worksite Wellness Committee Members

_________________________________________ _________________________________________

IT’S COMING!

ATTENTION

WELLNESS COMMITTEE GUIDE 13

11. Policy & Environmental Survey (10 minutes)

Distribute a copy of the Policy and Environmental Survey (Appendix J)

to the committee members. The committee members need to complete

this survey and return to the committee chair by a specified date (before

the next meeting so the chair will have time to compile the results for

discussion at that meeting).

The results of this survey will help the committee determine the

long-term goals for the Worksite Wellness Committee Action Plan.

12. Schedule Future Meetings (10 minutes)

It is recommended that the committee members schedule the future

five committee meetings at this point. The second meeting should be

scheduled within one month of the first meeting. Allow 60-90 minutes

for each meeting.The following timeline is suggested over a twelve-

month period:

• Second meeting—month 2

________________________________________________________

• Third meeting—month 3

________________________________________________________

• Fourth meeting—month 6

________________________________________________________

• Fifth meeting—month 9

________________________________________________________

• Year-end meeting—month 12

________________________________________________________

13. Adjourn

Reminder: The chairperson should send a

meeting reminder notice to all committee

members at least one week prior to the next

meeting. Minutes from this meeting can be

included with that reminder.

WORK WELL NC

Policy & Environment Survey

Directions:•Thissurveyiscompletedbytheworksitewellnesscommitteemembersonly.

 •Pleasecircleyouranswertoeachofthequestions.

 •ChooseN/Aonanyquestionthatdoesnotapplytoyourworksite.

1. Doesyourworksitehaveanywrittenpolicyorpoliciesrecommending Yes No NotSure N/A

theuseofhealthierfoodsforholidaycelebrationsorstaffmeetings?

2. IfYes,areemployeestoldaboutthehealthyfoodspolicyorpolicies Yes No NotSure N/A

duringorientation?

3. Doesyourworksitehavearefrigeratordesignatedforfoodfor Yes No NotSure N/A

employeestouse?

4. Doesyourworksitehaveanyequipmentandsinkaccessavailable Yes No NotSure N/A

foremployeestousetoprepareandeatmeals?

5. Doesyourworksitehaveanyvendingmachines? Yes No NotSure N/A

6. IfYes,dothevendingmachine(s)offeratleast5healthychoices? Yes No NotSure N/A

Healthychoicesincludefreshfruits,wholegrainchips,orbakedchips,etc.

7. Doesyourworksitehaveacafeteria? Yes No NotSure N/A

8. IfYes,Doesyourcafeteriaofferatleast5healthychoiceslike100% Yes No NotSure N/A

juiceproducts,freshfruits,orwholegrainproducts?

9. Hasinformationonhealthyfoodchoicesbeenprovidedtoemployees Yes No NotSure N/A

inthepastyear?

 How? _________________________________________________

10. Does

yourworksitehaveanywrittenpolicyorpoliciesencouraging Yes No NotSure N/A

physicalactivityduringtheworkday?

11. Doesyourworksitehavestairs? Yes No NotSure N/A

12. Ifyes,arethestairssafe,cleanandwell-lit? Yes No NotSure N/A

13. Doesyourworksitehaveasafeplaceforwalkingorotheractivities Yes No NotSure N/A

on-siteornear-by?

 Nameofnear-byfacility 

14. Doesyourworksitesponsoranyphysicalactivities,teamsorclubs? Yes No NotSure N/A

 Nameofactivity: ______________________________________

15. Doesyourworksitesponsoranycommunity-basedactivities,teams Yes No NotSure N/A

orclubs?

 Nameofactivity: ______________________________________

Continued

As a Reminder:

All WorkWell NC materials, including this

committee guide, are available for free download at

www.eatsmartmovemorenc.com/Worksites.html.

All files are available in PDF format for downloading

and printing. All agendas, letters, posters, as well as

all the resources, are available for easy use.

14 WorkWell NC

he objectives and detailed points of discussion

for the second meeting are provided below.

A sample agenda for the meeting is also provided

in Appendix P. You can also modify the objectives

and the agenda to better suit the needs and

organization of your particular worksite.

MEETING OBJECTIVES

• Outline plan to distribute and collect the Employee

Interest Survey

• Review results from the Policy & Environmental

Survey

• Identify funds for incentives and materials

• Discuss current and potential worksite policy for

wellness activities

Obtaining Employee Opinions—Key Items to Remember

This meeting will accomplish several major

tasks for the committee:

1. The Employee Interest Survey will be

discussed and distributed to all employees

at your worksite after this meeting. As a

committee chairperson and/or member,

it is critical that you support the work of

your committee and encourage your fellow

employees to complete the survey.

This is the key document for engaging

employees in the wellness activities selected

for their worksite, and finding out their

interests and needs will contribute to the

overall success of the committee’s work and

the worksite wellness program. The results

of this survey will guide the committee’s

short-term goals for your action plan and

the selection of the activities that will be

introduced at the worksite.

2. The Policy & Environmental Survey results

will be reviewed to help the group develop

long-term goals for the action plan regarding

policy/environment changes. The results of

the survey may very well show that there

are several issues that need to be addressed;

however, it is good to strive for one change

at a time. As policy/environment changes are

adopted (either formally or informally), new

action plans can be created to address other

issues.

3. Incentives and Work Time Considerations

for Activities may be discussed. This will

vary from worksite to worksite and is one

of the tasks that will involve management’s

input. As a reminder, the toolkit is equipped

with all the resources you need to start

wellness activities at your worksite. Incentives

and resources are an added bonus to your

program, should they be available.

Step 3: Second Meeting—

Obtaining Employee Opinions

WELLNESS COMMITTEE GUIDE 15

AGENDA ITEMS

1. Call meeting to order—Chairperson (5 minutes)

The committee chairperson should ask a volunteer to record the minutes

of the meeting.

2. Old Business—Chairperson (5–10 minutes)

Discuss any unfinished tasks from the previous meeting as indicated in

the minutes. Make a note of them here:

__________________________________________________________

3. Employee Interest Survey—Program Coordinator (10 minutes)

• Decide how to distribute the survey to employees at your worksite.

This may be done personally, through e-mail, mailboxes or some other

practical means depending upon the size of the facility and number of

employees. (Review Appendix O for survey distribution and collection

suggestions.)

• Decide the dates that the surveys will be distributed and when they

should be completed and returned. Allow at least one week for

employees to complete and return the survey to the specified person.

Also, the return date should be such that it gives a reasonable amount

of time for the Program Coordinator to compile the results for the

next committee meeting. Be sure to include this date on the survey in

the space provided before sending them out to the employees.

• The program coordinator distributes, collects and scores the survey

and reports the results at the next meeting. The score sheet for the

Employee Interest Survey is provided in Appendix R.

• The results of the Employee Interest Survey will be reviewed at the

next meeting and will be used by the committee to determine the

short-term goals (strategies) for the Action Plan.

4. Worksite Policy & Environmental Survey Report—

Chairperson (20 minutes)

The committee chairperson should have received the completed

worksite Policy and Environmental Survey from all the

committee members before this meeting. Also, using the

survey score sheet (provided in Appendix Q), the chairperson

should have arrived at the results for the survey. Discuss these

results with the committee members.

EmployEE IntErEst survEy scorE shEEt

Name of Worksite _____________________________________________

Total Number of Surveys Distributed ________________

Total Number of Surveys Returned _________________

Directions

1. Collect all completed Employee Interest Surveys.

2. For each question, add the response number that has been circled on all surveys. This will give you the

final score for each one of the questions from 1 to 27.

3. For example, if you collect 3 completed surveys and the responses for Question 1 on these surveys are:

3, 2 and 3, then the score for Question 1 is 3+2+3 = 8.

EAT SMART

1. I am interested in learning more about healthy food choices.

2. I am interested in learning how to incorporate fruits and vegetables into my diet.

3. I am interested in learning about healthier food choices and portions to help

manage my weight.

4. I am interested in participating in “tasting” events to sample healthy foods.

5. I am interested in having healthy snacks available for purchase at work.

MOVE MORE

6. I am interested in learning more about the benefits of physical activity.

7. I am interested in increasing my physical activity level.

8. I am interested in walking to increase physical activity.

9. I am interested in participating in team activities.

MANAGE STRESS

10. I am interested in learning ways to cope with feelings of stress.

11. I am interested in time management skills.

12. I am interested in improving my communication skills.

13. I am interested in learning skills to cope with change.

14. I am interested in organized social events with my co-workers.

Events might be holiday party or summer picnic.

WHEN EMPLOYEES WOULD MOST LIKELY PARTICIPATE IN PROGRAMS

15. I am interested in participating in wellness activities within my regular work schedule.

16. I am interested in participating in wellness activities before work.

17. I am interested in participating in wellness activities after work.

Score Sheet for Policy

and environment Survey

Name of Worksite _______________________________

Number of Completed Surveys ____________________

Count the total number of “NO” answers for questions 1–9

for all surveys completed by the committee members.

This is the EAT SMART score Out of possible score = 9

Count the total number of “NO” answers for questions 10–15

for all surveys completed by the committee members.

This is the MOVE MORE score Out of possible score = 6

Count the total number of “NO” answers for questions 16–19

for all surveys completed by the committee members.

This is the MANAGE STRESS score Out of possible score = 4

Count the total number of “NO” answers for questions 20–24

for all surveys completed by the committee members.

This is the QUIT NOW score Out of possible score = 5

Look at the scores for all the four policy/environmental areas. High numbers indicate areas where policy

and environmental changes are needed the most to make your workplace a healthier one.

Suggestions and ready-to-use resources for worksite policy and environmental changes in each of the four

areas are provided at www.eatsmartmovemorenc.com/Worksites.html.

16 WorkWell NC

Funding for incentives and materials—Chairperson (15 minutes)

1. What are the wellness committee’s funding needs?

_________________________________________________________________________

2. Is funding available from management?

_________________________________________________________________________

3. Is there any funding available from outside sources?

_________________________________________________________________________

• Report the total score for each of the following

from the survey score sheet

Eat Smart _________________

Move More _________________

Manage Stress _________________

Quit Now _________________

• A high score in any of the sections indicates that the committee needs

to consider selecting long-term goal(s) for promoting policy and/or

environmental changes at the worksite. Refer to the Sample Action Plan

(Appendix C) for examples.

Next, select activities that correspond to the committee’s long-term

goal(s). Visit www.eatsmartmovemorenc.com/Worksites.html for

program policy and environmental change suggestions. Refer to the

Sample Action Plan (Appendix C) to see how the strategies and steps

will be reported on your action plan.

Make a list of the strategies and steps that your worksite wellness

committee plans to implement. Record these on your Action Plan

(Appendix B).

Once the committee has determined the long-term goals for your

worksite, record the strategies on your action plan that will be

completed at the next meeting.

5. Management Issues—Chairperson (30 minutes)

The chairperson may need to assign one or two members of the

committee to follow up on the questions below and others that might arise

during discussion for reporting at the next meeting.

Note: The four focus areas are listed on the

score sheets in the same order as the survey

questions. In both the Employee Interest

Survey and the Policy and Environmental

Survey the tobacco use questions were listed

last as not all employees use tobacco.

WELLNESS COMMITTEE GUIDE 17

Worksite policy for wellness activities—Chairperson (15 minutes)

1. Who has authority to approve time considerations for activities during regular work hours?

_________________________________________________________________________

2. What might be the restrictions regarding wellness activities at the worksite?

_________________________________________________________________________

3. How much time is allowed for wellness activities—if any? Examples: 30 minutes per

employee 3 times a week; 15 minutes per employee daily paired with established break

time; 1 hour all employees once a month for group activity.

_________________________________________________________________________

6. Next meeting date(s)—Program Coordinator (10 minutes)

The committee may have already decided the dates for the upcoming

meetings during the first meeting. However, it would be beneficial to

review these dates once again, both as a reminder and to provide an

opportunity for any changes.

Third meeting: _____________________________________

Fourth meeting: _____________________________________

Fifth meeting: _____________________________________

Year-end meeting: _____________________________________

7. Adjourn

Reminder: The chairperson should send a meeting reminder notice to all

committee members at least one week prior to the next meeting. Minutes

from this meeting can be included with that reminder.

18 WorkWell NC

MEETING OBJECTIVES

• Review results from the Employee Interest Survey

• Identify short-term goals (based on Employee

Interest Survey)

• Review long-term goals (based on Policy and

Environmental Survey)

• Create an Action Plan for your worksite wellness

program

• Schedule follow-up meeting to check progress

AGENDA ITEMS

1. Call meeting to order—Chairperson (5 minutes)

The committee chairperson should ask for a

volunteer to record the minutes of the meeting.

2. Old Business—Chairperson (5-10 minutes)

Discuss any unfinished tasks from the previous

meeting as indicated in the minutes.

______________________________________

3. Employee Interest Survey Report—Program

Coordinator (20 minutes)

The Program Coordinator should have received

all completed Employee Interest Surveys

from the employees at the worksite before this

meeting. Also, using the survey score sheet

(Appendix Q), the Program Coordinator should

have arrived at the results for the survey.

(Note: The Coordinator may have asked for help

from one or two other committee members to

analyze the results of this survey, depending upon

the size of the worksite and the response rate

for the survey. See Appendix O for additional

suggestions.)

Discuss these results with other committee

members.

• Total # of Surveys Distributed _________

• Total # of Surveys Returned __________

The score for each of the questions in the

Employee Interest Survey reflects the level of

employee interest in that particular area. High

numbers indicate higher level of interest. As a

team, look at the scores and identify the areas

that your worksite wellness committee would like

to address first.

Report the total score for each of the following

from the survey score sheet

Eat Smart __________________

Move More __________________

Manage Stress __________________

Quit Now __________________

A high score in any of the sections indicates that

the committee needs to consider selecting short-

term goal(s) for promoting individual behavior

change of employees. Refer to the Sample Action

Plan (Appendix C) for examples.

Note: The four focus areas are listed on the

score sheets in the same order as the survey

questions. In both the Employee Interest

Survey and the Policy and Environmental

Survey the tobacco use questions were listed

last as not all employee use tobacco.

Step 4: Third Meeting—

Developing an Action Plan

WELLNESS COMMITTEE GUIDE 19

Next, select activities that correspond to the committee’s short-term

goal(s). The committee can utilize the resources found at

www.eatsmartmovemorenc.com/Worksites.html to plan short term

goals and programs.

Refer to the Sample Action Plan (Appendix C) to see how the

strategies and steps will need to be reported on your action plan.

Make a list of the strategies and steps that your worksite wellness

committee plans to implement.

Once the committee has determined the short-term goals for your

worksite, the strategies and steps are ready to be recorded on your

action plan (Appendix B).

4. Developing the Action Plan—Chairperson (20 minutes)

Record the following information on Worksite Wellness Committee

Action Plan (Appendix B):

• Worksite

• Committee Name

• Committee Chairperson

• Program Chair

• Other Chairs

• Mission Statement

• Communication Plan

• Committee Members

• Short-Term Goals—Strategies and Steps

Determine committee members responsible for each strategy

Decide date of implementation

Record results and outcomes after each activity

• Long-Term Goals—Strategies and Steps

Determine committee members responsible for each strategy

Decide date of implementation

Record results and outcomes after each activity

• Year-End Evaluation Summary—to be completed at the last meeting

• Recommendations from the Committee—to be completed at the last

meeting

5. Evaluate Employee Program Activities

Be sure to think about ways to get feedback from employees on the

individual and/or group activities that you implement at your worksite.

One way is to have employees sign up for activities and provide their

email addresses so that once the activity is completed, you can email

them a short survey about the activity. (See Appendix S.)

The evaluation information collected through employee feedback will

need to be summarized in the Results/Outcomes section of the action

plan. (See Appendix S for an example of a program/ activity evaluation

Adopt and begin implementation of your

Worksite Wellness Committee Action Plan.

20 WorkWell NC

form.)

6. Next meeting date(s)—Program Coordinator (5 minutes)

Remind the committee members of the dates for future meetings to check

the progress of the action plan. This will also

provide an opportunity to make any changes to

the scheduled dates, if needed.

Fourth meeting: ______________________

Fifth meeting: ______________________

Year-end meeting: ______________________

7. Adjourn

Reminder: The chairperson should send a meeting

reminder notice to all committee members at least

one week prior to the next meeting. Minutes from

this meeting can be included with that reminder.

Simple Guidelines for

Documenting Programs/

Activities

Be sure to document all the events associated

with any of the programs/activities that you

implement at your worksite. For example:

• Write a short summary of the program activity.

• Keep a list of all those who participate.

Document the number of employees who

participate in each activity.

• Take pictures at your event. This is a great way

to advertise and promote future events.

• As soon as the activity is completed, have

employees complete the Employee Program and/

or Activity Evaluation survey. (Appendix S)

• Review the evaluations and prepare a short

summary of the successes and/or lessons

learned.

• Record the information on the committee’s

action plan.

• Compile additional information about committee

work in a binder.

WELLNESS COMMITTEE GUIDE 21

MEETING OBJECTIVES

• Assess progress of the adopted action plan

• Change or revise action plan if needed

• Determine if new or additional strategies and steps

should be initiated

AGENDA ITEMS

1. Call meeting to order—Chairperson (5 minutes)

The committee chairperson should ask a

volunteer to record the minutes of the meeting.

2. Old Business—Chairperson (5-10 minutes)

Discuss any unfinished tasks from the previous

meeting as indicated in the minutes.

_____________________________________

3. Action Plan Progress Update—Program

Coordinator (40 minutes)

• As a team review the implementation of the

action plan that was completed during the last

meeting. The committee members may want to

discuss whether the strategies and steps were

started and/or completed on the specified

dates and whether the employees are motivated

to participate in wellness program activities.

• Also discuss any obstacles or problems

encountered in the implementation of the

action plan. This meeting should serve as an

opportunity for the worksite wellness committee

to revise or update the action plan to better

suit the needs of their worksite and employees.

The committee should discuss the need for

any changes to current strategies or addition of

new strategies that would help to improve the

effectiveness of the worksite wellness program.

The action plan should be updated to reflect any

changes or additions.

_____________________________________

4. Next meeting date(s)—Program Coordinator

(5 minutes)

Remind the committee members of the

dates for upcoming meetings to asses further

progress of the action plan. It will also provide

an opportunity to make any changes to the

scheduled dates, if needed.

Fifth meeting: __________________

Year-end meeting: __________________

5. Adjourn

Reminder: The chairperson should send a meeting

reminder notice to all committee members at least

one week prior to the next meeting. Minutes from

this meeting can be included with that reminder.

Step 5: Fourth Meeting—

Updating Progr am Progress

22 WorkWell NC

MEETING OBJECTIVES

• Assess progress of the adopted action plan

• Change or revise action plan if needed

• Determine if new or additional strategies and steps

should be initiated

• Decide on the overall worksite wellness program

evaluation plan

AGENDA ITEMS

1. Call meeting to order—Chairperson (5 minutes)

The committee chairperson should ask a

volunteer to record the minutes of the meeting.

2. Old Business—Chairperson (5-10 minutes)

Discuss any unfinished tasks from the previous

meeting as indicated in the minutes.

______________________________________

3. Action Plan Progress Update—Program

Coordinator (25 minutes)

• As a team review the implementation and

progress of the action plan. The committee

members should discuss whether the strategies

and steps were completed on the

specified dates and whether the wellness

program is being accepted at the worksite.

• Also at this point discuss any obstacles or

problems encountered in the implementation of

the action plan. This meeting should serve as an

opportunity for the worksite wellness committee

to revise or update the program action plan

to better suit the needs of their worksite and

employees. The committee should discuss

the need for any changes to current activities

or addition of new activities that would help

to improve the effectiveness of the worksite

wellness program. The action plan should be

updated to reflect any changes or additions.

______________________________________

4. Overall Evaluation Plan—Chairperson

(15 minutes)

The worksite wellness committee should decide

on a plan to evaluate the results of the overall

wellness program conducted at the worksite.

The committee can obtain information about the

effectiveness of the activities completed at their

worksite by:

• repeating the Policy and Environment Survey

by committee members (Appendix J), and

• conducting the Employee Satisfaction Survey

(Appendix T).

Since the next committee meeting will be the last

one for the current program year, these surveys

should be conducted before this meeting. This

will allow committee members time to discuss

the results of the surveys and have program

evaluation information to share during the last

meeting.

Step 6: Fifth Meeting—

Updating and Evaluating

WELLNESS COMMITTEE GUIDE 23

Decide on the dates that these surveys will be distributed,

collected and analyzed and the person(s) responsible.

Survey Distribution Date/ Collection Date/ Analysis Date/

Responsible Member Responsible Member Responsible Member

Policy &

Environment

Survey

Employee

Satisfaction

Survey

5. Next meeting date(s)—

Program Coordinator

(5 minutes)

Remind the committee

members of the date

for the next meeting to

evaluate the impact and

results of the wellness

committee. This will also

provide an opportunity

to make changes to the

scheduled date, if needed.

Year-end meeting:

___________________

6. Adjourn

Reminder: The chairperson

should send a meeting

reminder notice to all

committee members at least

one week prior to the next

meeting. Minutes from this

meeting can be included

with that reminder.

Notes for Creating

the Program Evaluation Plan

• The Policy and Environment Survey (Appendix J) should be

completed by worksite wellness committee members only. The

Employee Satisfaction Survey (Appendix T) should be distributed

to all employees at the worksite. (See Appendix O for distribution

and collection suggestions.)

• Select the distribution dates about one month before the scheduled

date for the year-end meeting.

• Also, the date by which the committee members/employees return

the completed surveys should be at least two weeks prior to the last

meeting. This will provide ample time for the committee member(s)

responsible for analyzing the surveys.

• The completed Policy and Environment Surveys can be scored using

the score sheet provided in Appendix R. Ideally, the results should

show improved scores in the wellness topic that was targeted for

intervention.

• Before distributing the Employee Satisfaction Survey to employees,

clearly specify the return date and name of the person responsible for

collecting the surveys on the survey form.

• Depending upon the number of employees at your worksite, the

analysis of completed Employee Satisfaction Surveys may need time

input from more than one committee member.

• The results of the completed Employee Satisfaction Surveys can be

reported using the outline provided in Appendix U. This will help

simplify the evaluation of wellness program/activities during the

year-end committee meeting. It also provides an easy summary for

reporting your results to others

24 WorkWell NC

MEETING OBJECTIVES

• Complete Year-End Evaluation Summary

Evaluate the Worksite Wellness Program

using the

—Action Plan Results/Outcomes

—Employee Satisfaction Survey

—Policy and Environment Survey (Repeat)

Provide recommendations from the Committee

for the next year

• Schedule the Wellness Committee first committee

meeting for the upcoming year.

AGENDA ITEMS

1. Call meeting to order—Chairperson

(5 minutes)

The committee chairperson should ask

a volunteer to record the minutes of the

meeting.

2. Worksite Wellness Program

Evaluation—Chairperson (20 minutes)

• The program chair should report from

the action plan the results/outcomes of all

activities and/or programs initiated.

• The committee member(s) responsible for

collection and analysis of the Employee

Satisfaction Survey and the repeat Policy

and Environment Survey should present

those results to the committee.

Employee Satisfaction Survey results may be

reported using the outline provided in Appendix

U. The committee as a group should discuss and

summarize the results as recommendations for the

next year’s worksite wellness program.

Successes: ______________________________

_______________________________________

Barriers: ________________________________

_______________________________________

THE PROCESS OF PROGRAM EVALUATION

serves several purposes. It:

• Helps the committee stay focused on short- and

long-term goals

• Provides information for decision making on all

aspects of the program

• Identifies areas where the design and delivery of

activities may need improvement or change

• Increases the application of learning by participants

• Allows for program accountability

• Provides data on the major accomplishments of the

program

• Identifies way to improve future programs

Step 7: Year End Meeting—

Evaluating Committee Activities

WELLNESS COMMITTEE GUIDE 25

The repeated Policy and Environment Survey should have been analyzed

using the survey score sheet provided in Appendix R. Ideally, the results

should show improved scores in the wellness topic that was targeted for

intervention.

The committee should summarize and discuss these results. Compile them

in a binder or folder for the next year’s wellness committee. Documenting

successes and barriers will help next year’s willness committee to plan

effectively.

Successes: _________________________________________________

_________________________________________________________

Barriers: ___________________________________________________

_________________________________________________________

• The committee chairperson should ask for any other recommendations

to carry forward to the next year’s committee program of work.

• The committee chairperson should complete the action plan by

recording the year-end evaluation summary information provided

above. A copy of the completed action plan should be sent to worksite

management.

4. Next Year Implementation of the WorkWell NC Wellness Committee

Guide—Chairperson (15 minutes)

The year-end meeting should also serve as an opportunity for the worksite

wellness committee members to realize that it is not the end of the

worksite wellness program but a time to continue to build upon enhancing

the health of employees at their worksite.

The committee members may wish to review the roles and responsibilities

that they fulfilled during the entire implementation period. Committee

members may continue to serve on the committee or may choose to step

down to open space for new members.

It is suggested that the committee compile minutes, copies of surveys,

survey reports, completed action plan and any other documents pertinent

to the committee. These files can be recorded to CD or as hard copies in a

three-ring binder.

5. Adjourn

26 WorkWell NC

APPENDICES

Wellness Committee Guide

28 WorkWell NC

APPENDIX A: Five Components of Comprehensive Programs

Five Components

of Comprehensive Programs

1. Health Education

Examples: Health promotion literature, newsletters, seminars, education sessions

such as lunch-n-learns, classes or lectures, etc.

2. Supportive Social and Physical Environments

Examples: Incentives, walking/running groups, exercise or fitness classes/groups,

facilities (showers, locker rooms, on-site gyms, etc.) offered, bike racks or storage,

gym memberships, food services and facilities (cafeterias, vending, preparation

and storage) offered, lactation support, tobacco-free facilities, etc.

3. Integration of Worksite Program

into Organizational Structure

Examples: Existence of formal health and wellness policies, dedicated staff and

employees plan programs, management and supervisors are involved in planning

and support implementation, employee access and program utilization

is encouraged

4. Linkages with Related Programs

(EAP, Safety, etc.)

Examples: Employee assistance, occupational health and safety programs, health

benefits or flexible spending accounts, flexible/telecommute schedules, or other

programs

5. Screening Programs

Examples: Mental health, blood pressure, diabetes, substance abuse,

mammography, stress, cholesterol, Health Risk Appraisal, etc.

WELLNESS COMMITTEE GUIDE 29

APPENDIX B: Wellness Committee Action Plan Template, page 1

Wellness Committee Action Plan

Organization:

Program Coordinator:

Planning Chairperson:

Period Beginning:

Period Ending:

Vision Statement:

Goals:

Period Budget:

Overall Marketing and Communications Strategies:

30 WorkWell NC

APPENDIX B: Wellness Committee Action Plan Template, page 2

Goal # _____:

Strategy: Timeline: Responsible

Member

Budget: Marketing and

Communications

Evaluation

Strategy:

Final Results:

Strategy: Timeline: Responsible

Member

Budget: Marketing and

Communications

Evaluation

Strategy:

Final Results:

Strategy: Timeline: Responsible

Member

Budget: Marketing and

Communications

Evaluation

Strategy:

Final Results:

WELLNESS COMMITTEE GUIDE 31

APPENDIX C: Wellness Committee Action Plan Sample, page 1

SAMPLE Wellness Committee Action Plan

Organization: ABC Corporation

Program Coordinator: Sally Jo Smith

Planning Chairperson: Bruce Morgan

Period Beginning: January 1, 2011

Period Ending: December 31, 2011

Vision Statement:

To provide a work culture that supports our employees’ health.

Goals:

1. Improve access to healthy foods and beverages during the work day

2. Encourage employees to be physically active during the work day

Period Budget:

$500.00

Overall Marketing and Communications Strategies:

• Establish a bulletin board for print announcements, flyers and general wellness information.

• Establish a posted calendar mark the start and end date of all activities.

• Establish wellness updates as a standing agenda item for all staff meetings

32 WorkWell NC

APPENDIX C: Wellness Committee Action Plan Sample, page 2

Goal # ___1__: Improve access to healthy foods and beverages during the work day

Strategy: Timeline: Responsible

Member

Budget: Marketing and

Communications

Evaluation

Strategy:

By July 2011, all snack Negotiations Sally Jo Morgan $ 0.00 1. Bulletin board 1. new contract

and beverage vending complete by in coordination 2. Staff meeting 2. visual

machines will provide April 2011, with leadership updates inspection

at least 50% healthy Note: 3. Signage

snacks and beverages. New vending Consider a price in break room

available to staff adjustment to & on vending Final Results:

by June 2011. boost revenue. machines

Strategy: Timeline: Responsible

Member

Budget: Marketing and

Communications

Evaluation

Strategy:

By February 2011, draft Draft by 2-1-11 Bruce Morgan $ 0.00 1. Educate all 1. new policy

and adopt new policy to Supervisors 2. review food

require healthy food & Revise by 2-9-11 2. Staff meeting and beverage

beverage choices at all updates served

company sponsored Adopt by 3-1-11

meetings and events. Final Results:

Strategy: Timeline: Responsible

Member

Budget: Marketing and

Communications

Evaluation

Strategy:

By November 2011, host Locate provider Sally Jo Morgan 1. total events

a minimum of 3 lunch by 2-15-2011. 2. session topics

and learn sessions on 3. participation

healthy eating behaviors. Finalize topics,

dates and Final Results:

locations.

WELLNESS COMMITTEE GUIDE 33

Date ______________________

Dear ______________________,

You are invited to serve on the Worksite Wellness Committee. The committee will meet on

(insert date, time and location). Please check with your immediate supervisor to confirm that

your participation and responsibility to the Worksite Wellness Committee is approved and will be

reflected in your annual work plan. I am available to explain to your supervisor the nature of the

committee and general time commitments.

The major responsibilities of the Worksite Wellness Committee would include but would not be

limited to: communicating the wellness program to employees at our worksite, advocating for

policies that support health, promoting participation in wellness activities, managing the activities

and evaluating the impact of the wellness program.

If you cannot serve on the Committee at this time, please notify me as soon as possible.

Sincerely,

(Signature—Supervisor/Manager)

APPENDIX D: Sample Letter of Invitation to Serve

on the Worksite Wellness Committee

34 WorkWell NC

APPENDIX E: Worksite Wellness Committee Invitation Poster

__________________________________________________________________________________

(name of worksite)

has a golden opportunity to Work Well.

Join the

Worksite Wellness

Committee

Contact __________________________________________________________________________

to learn more about the program and the responsibilities of serving on the

worksite wellness committee.

Contact: ____________________________________________________________________________

Email ___________________________________ Phone ___________________________________

Do YOU want to be a

leader in realizing the

WorkWell NC goal?

WELLNESS COMMITTEE GUIDE 35

WORKSITE WELLNESS COMMITTEE MEMBERS

Name of Worksite _____________________________________________________________________

Member Name Supervisor Approval Workplan Revision

10.

11.

12.

APPENDIX F: Worksite Wellness Committee Members

36 WorkWell NC

WELLNESS COMMITTEE MEETING

Worksite Name: ______________________________________________

Date: _______________________ Time: __________________________

AGENDA

Call meeting to order

Introductions—Committee Members

Share your name, department, favorite food and one favorite physical activity

Sign Committee Communication list—name, email address and phone number

Orientation to WorkWell NC Wellness Committee Guide

5 Components of a Comprehensive Program (Appendix A)

Overview of the WorkWell NC resources available at www.eatsmartmovemorenc.com/Worksites.

html

Committee Name

Mission Statement

Committee Chairperson and Program Coordinator Selection

Employee Communication Plan

Overview of Action Plan and Surveys

Worksite Wellness Committee Action Plan (Appendix B)

Worksite Wellness Committee Action Plan Sample (Appendix C)

Employee Interest Survey (Appendix I)

Policy and Environment Survey (Appendix J)

Schedule Future Meetings

Adjourn

APPENDIX G: First Meeting—Sample Agenda

WELLNESS COMMITTEE GUIDE 37

APPENDIX H: Sample Mission Statements

SAMPLE MISSION STATEMENTS

The mission statement should be a global expression of what the Worksite Wellness Committee wants to

accomplish. The mission statement may include a description of the value of the program to the worksite

and to its employees. You may decide on a mission statement that reflects the work the committee wants to

accomplish. You may choose to select one from these or create your own.

Examples:

“ The mission of the (name of worksite) Worksite Wellness Committee is to establish and

maintain a worksite that encourages environmental and social support for a healthy

lifestyle.”

“ To encourage employees’ personal and professional productivity, and physical and mental

well-being, the mission of the (name of worksite) Worksite Wellness Committee shall be to

promote a worksite culture that supports employees’ desire to make healthy lifestyle choices.”

“ Because employees spend 40 hours a week at work, it is important that the worksite be a

healthy place to work and support healthy choices for employees. It is the mission of the

(name of worksite) Worksite Wellness Committee to work toward implementing policies that

support a healthy worksite and healthy employees.”

“ The worksite wellness committee will work to provide opportunities for employees to develop

healthier lifestyles by supporting the adoption of habits and attitudes that contribute to their

positive well-being.”

38 WorkWell NC

APPENDIX I: Employee Interest Survey, page 1

Employee Interest

Survey

Directions: Indicate your interest for each of the following by circling:

1: little or no interest 2: some interest 3: very interested

I am interested in:

1. learning more about healthy food choices. 1 2 3

2. learning how to incorporate fruits and vegetables into my diet. 1 2 3

3. learning about healthier food choices and portions to help manage 1 2 3

my weight.

4. participating in “tasting” events to sample healthy foods. 1 2 3

5. having healthy snacks available for purchase at work. 1 2 3

6. learning more about the benefits of physical activity 1 2 3

and how it can influence my health.

7. increasing my physical activity level. 1 2 3

8. walking to increase physical activity. 1 2 3

9. participating in team activities. 1 2 3

10. learning ways to cope with feelings of stress. 1 2 3

11. time management skills. 1 2 3

12. improving my communication skills. 1 2 3

13. learning skills to cope with change. 1 2 3

14. organized social events with my co-workers. 1 2 3

Events might be holiday party or summer picnic.

15. participating in wellness activities within my regular work schedule. 1 2 3

16. participating in wellness activities before work 1 2 3

17. participating in wellness activities after work. 1 2 3

18. 10-15 minute activities that I can do two to three times a day. 1 2 3

19. activities that last 30–60 minutes. 1 2 3

20. health information that I can read, listen to, or watch 1 2 3

on my own.

21. participating with a group to learn more about wellness. 1 2 3

Continued

WELLNESS COMMITTEE GUIDE 39

APPENDIX I: Employee Interest Survey, page 2

Directions: Indicate your interest for each of the following by circling:

1: little or no interest 2: some interest 3: very interested

I am interested in:

22. working in a tobacco-free environment. 1 2 3

23. working with others to reduce second-hand smoke 1 2 3

in my workplace.

Please complete questions 24–27 only if you currently use tobacco.

24. getting information about quitting tobacco use. 1 2 3

25. attending information sessions or classes about quitting 1 2 3

tobacco use.

26. using my meal break time to learn about quitting the use 1 2 3

of tobacco.

27. using time before or after work to learn about quitting the 1 2 3

use of tobacco.

Please return this survey to: ___________________________________________

By this date: ___________________________________________

40 WorkWell NC

APPENDIX J: Policy and Environment Survey, page 1

Policy & Environment

Survey

Directions:•Thissurveyiscompletedbytheworksitewellnesscommitteemembersonly.

 •Pleasecircleyouranswertoeachofthequestions.

 •ChooseN/Aonanyquestionthatdoesnotapplytoyourworksite.

1. Doesyourworksitehaveanywrittenpolicyorpoliciesrecommending Yes No NotSure N/A

theuseofhealthierfoodsforholidaycelebrationsorstaffmeetings?

2. IfYes,areemployeestoldaboutthehealthyfoodspolicyorpolicies Yes No NotSure N/A

duringorientation?

3. Doesyourworksitehavearefrigeratordesignatedforfoodfor Yes No NotSure N/A

employeestouse?

4. Doesyourworksitehaveanyequipmentandsinkaccessavailable Yes No NotSure N/A

foremployeestousetoprepareandeatmeals?

5. Doesyourworksitehaveanyvendingmachines? Yes No NotSure N/A

6. IfYes,dothevendingmachine(s)offeratleast5healthychoices? Yes No NotSure N/A

Healthychoicesincludefreshfruits,wholegrainchips,orbakedchips,etc.

7. Doesyourworksitehaveacafeteria? Yes No NotSure N/A

8. IfYes,Doesyourcafeteriaofferatleast5healthychoiceslike100% Yes No NotSure N/A

juiceproducts,freshfruits,orwholegrainproducts?

9. Hasinformationonhealthyfoodchoicesbeenprovidedtoemployees Yes No NotSure N/A

inthepastyear?

 How? _________________________________________________

10. 

Doesyourworksitehaveanywrittenpolicyorpoliciesencouraging Yes No NotSure N/A

physicalactivityduringtheworkday?

11. Doesyourworksitehavestairs? Yes No NotSure N/A

12. Ifyes,arethestairssafe,cleanandwell-lit? Yes No NotSure N/A

13. Doesyourworksitehaveasafeplaceforwalkingorotheractivities Yes No NotSure N/A

on-siteornear-by?

 Nameofnear-byfacility 

14. Doesyourworksitesponsoranyphysicalactivities,teamsorclubs? Yes No NotSure N/A

 Nameofactivity: ______________________________________

15. Doesyourworksitesponsoranycommunity-basedactivities,teams Yes No NotSure N/A

orclubs?

 Nameofactivity: ______________________________________

Continued

WELLNESS COMMITTEE GUIDE 41

APPENDIX J: Policy and Environment Survey, page 2

16. Hasinformationonphysicalactivitybeenprovidedtoemployees Yes No NotSure N/A

inthepastyear?

 Howprovided? ________________________________________

17. Doesyourworksitehaveanywrittenpolicyorpoliciessupporting Yes No NotSure N/A

andencouragingcommunicationthatisopen,two-wayandrespectful

ofemployeediversity?

18. Doesyourworksitehaveanyplaceforemployeestoreducethe Yes No NotSure N/A

physicalandmentalstressoftheworkday?

19. Hasanyactivityoractivitiesbeenprovidedfordealingwith Yes No NotSure N/A

significantchangesintheworksiteinthepast2years?Asignificant

changemaybeachangeinmanagement,highstaffturnoverorloss,

orchangesinworkconditions?

 Whatwasdone? _______________________________________

20. Hasanyprogram(s)ormaterial(s)formanagingstressbeenprovided Yes No NotSure N/A

atyourworksiteinthepastyear?Thismightbeaclassforsupervisors,

relaxation,communication,ortimemanagement.

 Whatwasprovided?_ __________________________________

21. Doesyourworksitehaveanywrittenpolicyorpoliciesthatprohibit Yes No NotSure N/A

orrestrictsmokingattheworksite?

21a.IfYes,issmokingpermittedoutsideonworksitegrounds? Yes No NotSure N/A

21b.IfYes,issmokingpermittedanywhereinworksitebuildings? Yes No NotSure N/A

22. IfYesto21aorb,aresignspostedforsmokingor

non-smokingareas? Yes No NotSure N/A

23. Aretobaccovendingmachinesorvendorsrestrictedorprohibited Yes No NotSure N/A

attheworksite?

24. Hasanyinformationonhealtheffectsoftobaccobeenprovidedto Yes No NotSure N/A

employeesinthepastyear?

 How? _________________________________________________

25. Havesmokingortobaccocessationprogramsbeenofferedon-site Yes No NotSure N/A

duringthelastyear?

 What? ________________________________________________

 Pleasereturnthissurveyto: ________________________________________

 Bythisdate: ________________________________________

42 WorkWell NC

Appendix K: A Guide to Making Physical Activity a Part of Meetings,

Conferences and Events

, page 1

Move More North Carolina:

A guide to making physical activity

a part of meetings, conferences and events

Moving more means getting physical activity wherever

we spend our time. In general, the more physical activity

we do the more beneﬁts we get. Even short amounts—

10 minutes or more—offer beneﬁts. A great way

to make it easy to move more is to make

physical activity a part of meetings, conferences

and events. Providing an opportunity for

people to get up and move around helps them

re-focus and re-energize after sitting for long

periods of time.

Use this guide to make physical activity

a part of your next event. It does not

matter if the event is one hour or

three days, everyone will beneﬁt

from the chance to move more.

WELLNESS COMMITTEE GUIDE 43

Appendix K: A Guide to Making Physical Activity a Part of Meetings,

Conferences and Events

, page 2

Planning

Physical activity should be

planned like any other part

of an event. Consider how

and when to offer physical

activity, and what resources,

if any, you will need.

Physical activity should also

be included on the agenda

and in event materials so

that participants can be

ready to participate.

One-hour to One-day

Events

When planning an event that will

last between one hour and one

day, there are several options for

making physical activity a part of

the event:

• Include short physical

activity breaks throughout

the agenda. Provide a stretch

break, play music and let

everyone dance or do an “active

ice breaker” to get everyone up

and moving.

• Provide time for a walk

break before or after

lunch. Choose a location that

has access to safe walking routes

and have a volunteer lead a

walk before or after lunch. Or

suggest a route(s) and encourage

everyone to walk on their own.

Multi-day Events

When planning a multi-day

event, it is especially important to

include opportunities for physical

activity. Choose a location that

has access to physical activity

options. For example, safe places

to walk/jog, a ﬁtness/recreation

center, or places of interest within

safe walking distance, such as

restaurants, local attractions

or historic sites. If a ﬁtness/

recreation center is available, ask

if it is accessible to individuals of

all abilities.

There are many options for

providing physical activity during

a multi-day event:

• Organize a group walk.

Get a volunteer to lead a group

walk. Pick a time and place to

meet. Let everyone know the

projected pace and distance of

the walk.

• Offer a group exercise

class. Work with a local ﬁtness

center, which can provide a

certiﬁed instructor, to provide a

class on-site. Indicate what skill

level is needed for the class (for

example, beginner, intermediate

or advanced).

• Provide a free pass to a

local ﬁtness/recreation

center.

• Allow time in the agenda

for physical activity. Provide

time on the agenda in the

morning or late afternoon for

physical activity. Adjust the

schedule by starting a little later

for early morning activity or

leave time in the afternoon for

activity before dinner.

• Include short physical

activity breaks throughout

the agenda. Provide a stretch

break, play music and let

everyone dance or do an “active

ice breaker” to get everyone up

and moving.

Event Materials

Promote physical activity options

in the event materials. Include

what options are available and

what participants should bring.

For example, if there will be a

walk during the day, suggest

bringing a comfortable pair of

walking shoes.

44 WorkWell NC

Mix and Match Motions

The following are ideas for physical activity breaks. Mix and match

the following motions or come up with your own.

MOTIONS

Leading Physical Activity Breaks

Ideas for Physical Activity

Breaks

Balance

Bend

Blow

Bounce

Brush

Build

Bump

Catch

Chew

Clap

Climb

Clog

Cycle

Dance

Fix

Float

Hit

Hop

Jump

Kick

Levitate

Lift

Paint

Pinch

Pirouette

Poke

Pop

Press

Pull

Push

Ride

Rotate

Roll

Run

Sashay

Serve

Shufﬂe

Skate

Ski

Skip

Slide

Slip

Slither

Spin

Swagger

Swim

Swing

Tap

Throw

Turn

Walk

Wave

Wiggle

Wipe

A physical activity break is

a structured, 10-15 minute

activity during the formal

agenda. Keep in mind that

attendees will have different

physical abilities. The purpose

of the break is to give everyone

the chance to move for a

couple of minutes. There are

a few things to consider when

leading a physical activity

break:

• Use inclusive language such

as “Stand up or roll back as

you’re able” to include those

in wheelchairs.

• Include upper body motions

that everyone can do,

even if they are sitting in a

wheelchair.

• Encourage people to move

only in ways they feel

comfortable.

• Consider what people are

wearing; if they are dressed

up in suits, skirts or high

heeled shoes, motions

may need to be

modiﬁed.

The following section

provides ideas for simple

physical activity breaks. Try

using one of these activities

at your next event to see how

easy it can be to help people

move more.

(Adapted from Energizers: Classroom-based Physical Activities.

Developed by the Activity Promotion Laboratory, School of Health

and Human Performance, East Carolina University available from

www.EatSmartMoveMoreNC.com)

Shoot a jump shot

Serve a tennis ball

Run through tires

Bat a baseball

Downhill ski

Spike a volleyball

Swing a golf club

Throw a football

Juggle a soccer ball

Shoot an arrow

Shoot a hockey puck

Swim underwater

Field a ground ball

Dunk a basketball

Sports for All

Call out the following sports skills and have everyone “do” the

activity:

Appendix K: A Guide to Making Physical Activity a Part of Meetings,

Conferences and Events

, page 3

WELLNESS COMMITTEE GUIDE 45

Leading Physical Activity Breaks

Adopt a policy

Make a commitment to providing physical activity

during meetings, conferences and events. Adopt a

policy to show your support of helping people move

more. An example of a model policy is provided on the

inside back cover of this guide.

What Is Your Favorite Activity?

Start by acting out a physical activity you enjoy: for

example, swimming. Act like you are swimming, while

saying, “I enjoy swimming.” The whole group also acts

like they are swimming. Then call on someone, “Mary,

what physical activity do you enjoy?”

and Mary replies by saying and acting

out her favorite activity. For example,

“My favorite activity is canoeing,”

and she acts as if she is canoeing. The

whole group acts as if they are canoeing.

Everyone should continue with the

current activity until the next activity

is called out, then they switch to the

new activity. This continues until

everyone has had a chance to share

an activity. If the group is small,

you may want to go around two

times. Encourage the group to be

creative and have fun!

Name Game

Ask each person to think of a verb, an action, which

starts with the same letter as their ﬁrst name, for

example, “Jumping James.” The person does the

action and calls out their action-name. Everyone then

repeats the action and the action-name. Continue until

everyone has a chance to say their name. If there is time

or if the group is small, go around again. If someone

says “I can’t think of anything,” say “Keep thinking,

we’ll come back to you.” If they still don’t come up with

anything, ask the group to help.

(From http://wilderdom.com/games/descriptions/

NamePantomime.html)

Dance Fever

Call out a type of dance or dance move and have

everyone do the move. Do each move for 1-3 minutes

before calling out the next one. Below are some

examples:

• The swim • The hand jive

• The twist • Staying alive

Ask the group to call out favorite dances while

everyone does it. If participants cannot stand, all of the

moves can be done seated.

Dance the Night Away

Lead the group through

a popular group dance

song. Use a song the

group would enjoy.

• Macarena

• Electric Slide

• YMCA • Twist and Shout

• The Twist • Boot Scoot Boogie

• Achy Breaky Heart • Cha Cha Slide

Invisible Beach Volleyball

Pass out invisible beach balls. Pass (carefully hit) them

around the room. Play along. You may want to make

a show of bringing the invisible balls into the room.

“Hand” them out to get them started. Encourage

participants to “hit” the balls in a variety of ways, for

example, with one hand, with two hands, spike, get

down low, to the side, in front, etc. Encourage everyone

to have fun!

Leader note: You can use other imaginary games such

as soccer, basketball or tennis.

Resources

Making physical activity a part of meetings, conferences

and events is a great way to keep everyone engaged,

focused and energized. Use your creativity and

imagination to get people up and moving.

Check out more resources to support eating smart

and moving more at: www.EatSmartMoveMoreNC.com.

Appendix K: A Guide to Making Physical Activity a Part of Meetings,

Conferences and Events

, page 4

46 WorkWell NC

6:30–7:00 a.m. Physical Activity

Option 1: Walk or jog on your own—maps of local routes are

available at the front desk.

Option 2: Group walk—a group will meet in the Lobby at 6:30 a.m.

Marie Smith will lead a 30-minute, self-paced walk.

Option 3: Group exercise class—Yoga: start your day with some

basic Yoga moves led by certied instructor Rob Miller. The class is

designed for all skill levels from beginner to advanced. The class will

meet in room B. Please bring a towel and water bottle.

7:30– 8:30 a.m. Breakfast

8:30 –10:00 a.m. Session I

10:00–10:15 a.m. Break

10:15–11:15 a.m. Session II

11:15–11:30 a.m. Move More Physical Activity Break

11:30–12:15 p.m. Session III

12:15–1:15 p.m. Lunch

Note: There is a .25-mile walking route in the garden next to the

hotel. Feel free to stroll through and enjoy the scenery before the

afternoon session.

1:15–2:20 p.m. Session IV

2:20–2:30 p.m. Break

2:30–3:30 p.m. Session V

3:30–3:40 p.m. Stretch Break

3:40–4:30 p.m. Session VI

4:30 p.m. Adjourn

Enjoy the following physical activity options on your own this

evening:

• Fitness Center

• A walk through historic downtown

• A walk/jog along the local greenway

SaMPle ageNda

Appendix K: A Guide to Making Physical Activity a Part of Meetings,

Conferences and Events

, page 5

WELLNESS COMMITTEE GUIDE 47

Move More North Carolina Sample Physical Activity Breaks Policy

For use in any organization, agency or community group that holds meetings, conferences or

other events.

Whereas:

____________________________________________________________(ﬁll in your organization name here)

is concerned about the health of its ________________________________________________ (members);

Whereas:

People are interested in eating smart and moving more;

Whereas:

Heart disease, cancer and stroke—the top three causes of death in North Carolina—are largely

affected by what we eat and how physically active we are;

Whereas:

Physical activity is associated with many positive health beneﬁts and can prevent or delay the

onset of many chronic diseases and short amounts, of 10 minutes or more, can contribute to these

beneﬁts;

Therefore:

Effective _________________________________________(today’s date), it is the policy of

_____________________________________________________________(ﬁll in your organization’s

name) that all meetings and events (examples of events may include: meetings, conferences, summits,

symposiums, etc.) sponsored or supported by this organization will always include opportunities

for physical activity by:

• Providing 10-minute physical activity breaks during the scheduled event.

• Providing time before and/or after the event for physical activity and adjusting the

schedule when necessary.

• Choosing venues that offer physical activity opportunities for participants.

• Providing encouragement from group leadership for physical activity.

___________________________________________________________________________________________

Signature Title

___________________________________________________________________________________________

Name of Organization

__________________________________

Date

Appendix K: A Guide to Making Physical Activity a Part of Meetings,

Conferences and Events

, page 6

48 WorkWell NC

APPENDIX L: Committee Members and Role Sharing

COMMITTEE MEMBERS AND ROLE SHARING

Worksite Wellness Committees can operate efficiently and avoid burn-out if members of the committee

share responsibilities. Some of the roles that can be shared on a worksite wellness committee include:

Committee Chairperson: This position can be shared by two employees as co-chairpersons. The

duties and responsibilities for one may be to handle the administration and communication needs of the

committee. The other co-chair might be responsible for the overall program activities of the committee.

Program Coordinator(s): The number of

program coordinators that the committee has

is usually dictated by the number of programs

and/or activities that are outlined in the action

plan. By assigning a program coordinator

to each activity that you implement at your

worksite, you do not place the burden of all

programs on one employee.

The important thing to remember is to share the

responsibility among committee members and

recruit employees who are not on the committee

as well to serve on sub-committees. Other

chairpersons that can be assigned and shared

include:

Communications Chair

Employee Interest Survey Chair

Event Planner Chair

Management Liaison Chair

Action Plan Chair

WELLNESS COMMITTEE GUIDE 49

APPENDIX M: Employee Interest Survey Distribution and

Collection Suggestions

Distribution

Method

Pros Cons Additional Information

Personal

Distribution

Low cost. Personal

contact with employees

might increase the

number of survey

responses. Personal

interaction will allow

wellness members to talk

about the importance of

completing the Employee

Interest Survey.

Could involve a significant time involvement

for large worksites. In facilities with different

shifts of employee work-time, committee

members would need to cover all shifts to

ensure distribution to all employees. Home-

based employees might not receive surveys.

Employees might be disbursed throughout

several worksites. Could involve a high level

of committee involvement in counting and

monitoring survey responses in large offices.

Personal distribution could be combined with

mailbox, paycheck stuffers, or email distribution

to include employees at all shifts and locations

(this would involve significant committee

involvement in identifying employees who

are home-based or work night-time shifts). In

smaller offices, surveys could be distributed and

completed in staff meetings, ensuring high levels

of survey responses.

Mailbox

stuffers

Low cost. Surveys can be

distributed with relative

ease.

Some employees might not check their

mailboxes. Could involve making high numbers

of copies in large offices. Could involve a high

level of committee involvement in counting and

monitoring survey responses in large offices.

Be sure to specify a specific survey collection

spot for employees to drop surveys.

Paycheck

stuffers,

Memo

addendums

Low cost. Surveys can be

distributed with relative

ease. Most employees

will receive (and open)

paychecks and employee

memos.

Could involve making high numbers of copies

in large offices. Method does not include

temporary staff. Could involve a high level

of committee involvement in counting and

monitoring survey responses in large offices.

Be sure to specify a specific survey collection

spot for employees to drop surveys.

distribution

No cost. Surveys can be

distributed very easily.

Employees might not respond to email. Method

does not include employees without email.

Could involve a high level of committee

involvement in counting and monitoring survey

responses in large offices.

Email distribution could be combined with

mailbox stuffers or paycheck stuffers to include

temporary and non-email staff

(this would involve significant committee

involvement in identifying employees

without computers).

Online

Surveys

Surveys could be

easily distributed via

email. Low level of

committee involvement

needed in tabulating

survey results— the

survey website will

collect and score data.

Very easy to monitor

the number of survey

responses.

Significant cost involved. Method does not

include employees without internet access.

Committee involvement needed in setting up

survey online.

Email notification of online survey site could be

combined with mailbox stuffers

or paycheck stuffers to include employees

without access to the internet (this would involve

significant committee involvement in identifying

employees without computers). The following

websites offer online surveys:

www.zommerang.com

www.surveymonkey.com

**Some things to keep in mind while distributing surveys:

1. Your wellness committee should consider setting a target date for receiving survey responses. Having a set date to return surveys will make some

employees more likely to complete them.

2. Consider having a drawing or incentives for employees who complete their surveys. These incentives or drawings do not have to cost money! For

example, your committee could: offer relief from shared office tasks (like cleaning common areas or contributing to the coffee fund) to the first 5

employees who finish their surveys; find a local business to donate a gift card to give to drawing winners; post a “thank you” note to employees

who complete their surveys in a visible notice board. (This could be done a week or a few days before the final collection date to remind others to

complete their surveys.)

3. Think about posting fliers or sending out reminder emails to keep employees informed about the importance of the Employee Interest Survey.

Remember: a few well placed fliers and a small number of emails will keep people’s attention. Try not to flood employees’ mailboxes with too

many emails or they will begin to delete them.

4. Remind Wellness Committee members to talk up the surveys! Committee members are your greatest assets and biggest champions. Members

can make short presentations in management or office staff meetings about the importance of the survey and the final collection date. Also, ask

them to talk about the importance of the Employee Interest Survey to their friends and co-workers. News will spread, generating greater survey

participation.

Ideas for Distributing Employee Interest Surveys

50 WorkWell NC

APPENDIX N: Worksite Wellness Committee Announcement

Your

Worksite

Wellness

Program

WorkWell NC

Worksite Wellness Coordinator

______________________________________________________________________________________

Worksite Wellness Committee Members

_________________________________________ _________________________________________

IT’S COMING!

ATTENTION

WELLNESS COMMITTEE GUIDE 51

APPENDIX O: Cover Letter for Employee Interest Survey

Dear Co-Workers,

In today’s fast paced world where most of our lifestyle choices are influenced by convenience and

technology, chronic health conditions/diseases have begun to rise at an alarming rate.

Also, most of the focus and expense of the healthcare industry has been for the treatment of

chronic diseases. By focusing on prevention, several chronic diseases can be prevented or made

less serious. Our employers can play a crucial role in helping us make healthier lifestyle choices

that can lead to a more enjoyable life for all of us.

A worksite wellness committee has been established to make our worksite a healthier workplace

and promote the health of our employees.

However, before the wellness committee can initiate wellness activities/programs at the worksite,

it is imperative to learn about the interests of our employees. The success of any worksite wellness

initiative will ultimately depend on what the employees want and will participate in. Please

complete the attached Employee Interest Survey and return to the committee member specified

below.

Return your completed survey to

______________________________________ by ___________________.

Thank you!

Worksite Wellness Committee

______________________________________________________________

(name of worksite)

52 WorkWell NC

APPENDIX P: Second Meeting—Sample Agenda

WELLNESS COMMITTEE MEETING

Worksite Name: ______________________________________________

Date: _______________________ Time: __________________________

AGENDA

Call meeting to order

Old Business

Employee Interest Survey

Establish plan for distribution and collection of surveys

Worksite Policy and Environment Survey Report

Report the results of the survey

Establish long-term goals (strategies and steps) for policy and/or

environmental changes at the worksite

Select resources from eatsmartmovemorenc.com/Worksites.html

Management Issues

Funding for incentives and materials

Worksite policies regarding wellness activities

Strategies for Communicating with Management

Review Schedule of Future Meetings

Adjourn

WELLNESS COMMITTEE GUIDE 53

APPENDIX Q: Score Sheet for Employee Interest Survey, page 1

EmployEE IntErEst survEy scorE shEEt

Name of Worksite _____________________________________________

Total Number of Surveys Distributed ________________

Total Number of Surveys Returned _________________

Directions

1. Collect all completed Employee Interest Surveys.

2. For each question, add the response number that has been circled on all surveys. This will give you the

final score for each one of the questions from 1 to 27.

3. For example, if you collect 3 completed surveys and the responses for Question 1 on these surveys are:

3, 2 and 3, then the score for Question 1 is 3+2+3 = 8.

EAT SMART

1. I am interested in learning more about healthy food choices.

2. I am interested in learning how to incorporate fruits and vegetables into my diet.

3. I am interested in learning about healthier food choices and portions to help

manage my weight.

4. I am interested in participating in “tasting” events to sample healthy foods.

5. I am interested in having healthy snacks available for purchase at work.

MOVE MORE

6. I am interested in learning more about the benefits of physical activity.

7. I am interested in increasing my physical activity level.

8. I am interested in walking to increase physical activity.

9. I am interested in participating in team activities.

MANAGE STRESS

10. I am interested in learning ways to cope with feelings of stress.

11. I am interested in time management skills.

12. I am interested in improving my communication skills.

13. I am interested in learning skills to cope with change.

14. I am interested in organized social events with my co-workers.

Events might be holiday party or summer picnic.

WHEN EMPLOYEES WOULD MOST LIKELY PARTICIPATE IN PROGRAMS

15. I am interested in participating in wellness activities within my regular work schedule.

16. I am interested in participating in wellness activities before work.

17. I am interested in participating in wellness activities after work.

54 WorkWell NC

APPENDIX Q: Score Sheet for Employee Interest Survey, page 2

HOW LONG EMPLOYEES WANT PROGRAMS TO LAST.

18. I am interested in 10-15 minute activities that I can do two to three times a day.

19. I am interested in activities that last 30-60 minutes.

INDIVIDUAL OR GROUP ACTIVITIES

20. I am interested in health information that I can read, listen to, or watch on my own.

21. I am interested in participating with a group to learn more about wellness.

SMOKEFREE WORKPLACE

22. I am interested in working in a tobacco-free environment.

23. I am interested in working with others to reduce second-hand smoke

in my workplace.

QUIT NOW

Tobacco Users. How many surveys had these questions completed?

24. I am interested in getting information about quitting tobacco use.

25. I am interested in attending information sessions or classes about quitting

tobacco use.

26. I am interested in using my meal break time to learn about quitting the use of tobacco.

27. I am interested in using time before work or after work to learn about quitting

the use of tobacco.

High scores indicate higher employee interest in that particular area. Suggestions and ready-

to-use resources for individual and group activities in each of the four areas are provided at

www.eatsmartmovemorenc.com/Worksites.html.

WELLNESS COMMITTEE GUIDE 55

APPENDIX R: Score Sheet for Policy & Environment Survey

Score Sheet for Policy

and environment Survey

Name of Worksite _______________________________

Number of Completed Surveys ____________________

Count the total number of “NO” answers for questions 1–9

for all surveys completed by the committee members.

This is the EAT SMART score Out of possible score = 9

Count the total number of “NO” answers for questions 10–15

for all surveys completed by the committee members.

This is the MOVE MORE score Out of possible score = 6

Count the total number of “NO” answers for questions 16–19

for all surveys completed by the committee members.

This is the MANAGE STRESS score Out of possible score = 4

Count the total number of “NO” answers for questions 20–24

for all surveys completed by the committee members.

This is the QUIT NOW score Out of possible score = 5

Look at the scores for all the four policy/environmental areas. High numbers indicate areas where policy

and environmental changes are needed the most to make your workplace a healthier one.

Suggestions and ready-to-use resources for worksite policy and environmental changes in each of the four

areas are provided at www.eatsmartmovemorenc.com/Worksites.html.

56 WorkWell NC

APPENDIX S: Employee Evaluation of a Worksite Activity

EMPLOYEE EVALUATION

OF A WORKSITE ACTIVITY

You recently participated in __________________________________________, a Worksite Wellness

Program activity provided by the Wellness Committee at your worksite.

Please complete this evaluation form in order to help the Wellness Committee create the best possible

wellness programs/activities at our worksite. Thank You!

Please indicate your level of agreement using this scale:

1=Strongly disagree 2= Disagree 3=Agree 4=Strongly agree NS=not sure

1. This activity has influenced me to make healthier lifestyle choices. 1 2 3 4 NS

2. I would like to participate in similar activities in the future. 1 2 3 4 NS

3. I would recommend this activity to my co-workers. 1 2 3 4 NS

The best/most helpful part of this activity was _________________________________________________

______________________________________________________________________________________

This activity could be improved by: _________________________________________________________

______________________________________________________________________________________

4. Please check any areas that you would like for wellness programs to be provided:

Healthy Eating Quit Tobacco Use

Physical Activity Stress Management

Please return this form to:

_____________________________________

WELLNESS COMMITTEE GUIDE 57

APPENDIX T: Employee Satisfaction

with Worksite Wellness Program

EMPLOYEE SATISFACTION

WITH WORKSITE WELLNESS PROGRAM

Name of Worksite: _____________________________________________ Date: __________________

1. Are you aware of the Worksite Wellness Program that has been Yes No

established at your worksite?

2. Are you interested in receiving additional information concerning Yes No

the Worksite Wellness Program?

3. Have you participated in any wellness activity(ies) conducted at your worksite? Yes No

4a. Have you made healthier lifestyle choices since the Worksite Wellness Program Yes No

was established at your worksite?

4b. If Yes, check areas where you have made healthier lifestyle choices (check all that apply).

Eating healthier Quit tobacco use

Increased physical activity Reduced stress level

5. Would you like to participate in future wellness activities at your worksite? Yes No

6. What improvements to the Worksite Wellness Program would you like to see?

__________________________________________________________________________________

Your input helps us make improvements to your Worksite Wellness Program. By completing this survey,

you help us to provide the best wellness programming and activities at our worksite. Thank you!

Please return to (contact person for Worksite Wellness Program):

______________________________________________

Return by (date): _______________________________

If you would like information from the Wellness Committee at your worksite, either contact the person

named above, or enter your name and contact information below.

______________________________________________

58 WorkWell NC

APPENDIX U: Employee Satisfaction Survey Results Form

EMPLOYEE SATISFACTION SURVEY

RESULTS FORM

Name of Worksite: _______________________________________________

Report Prepared by: ______________________________________________

Number of Surveys distributed: ___________

Number of Surveys returned: ___________

Percent (%) of employees aware of the worksite wellness program ______________

Percent (%) of employees aware of the worksite wellness committee ______________

Percent (%) of employees who participated in worksite wellness activities ______________

Percent (%) of employees who reported lifestyle changes occurred due to ______________

worksite wellness program activities

Percent (%) of employees who would like to participate in future worksite ______________

wellness program activities

WELLNESS COMMITTEE GUIDE 59

APPENDIX V: Evaluation of Wellness Committee

by Committee Members

EVALUATION

OF WELLNESS COMMITTEE

BY COMMITTEE MEMBERS

This questionnaire is designed to help your committee assess your Worksite Wellness Program and the

committee’s strengths and weaknesses. It is for your use only to guide your discussions of how well the

committee functions and how the wellness program could be improved. Feel free to add other questions

that you think would help this effort.

1. Are all areas of your worksite represented on your committee? Yes No

1a. How could representation be improved?

_______________________________________________________________________________________________________________________

2. Is management represented on your committee? Yes No

3a. In what ways has management been supportive of your efforts?

_______________________________________________________________________________________________________________________

3b. In what ways would you like management to be more supportive?

_______________________________________________________________________________________________________________________

4. Has the committee completed a written action plan? Yes No

4a. Does the action plan include at least one short-term and one Yes No

long-term objective?

4b. Have you implemented any activities from your action plan? Yes No

4c. Which behavior(s) does your action plan focus on?

Healthy Eating Quit Tobacco Use

Physical Activity Stress Management

5. What would help your committee do a better job of working together?

_______________________________________________________________________________________________________________________

6. In what ways is the wellness program helping employees?

_______________________________________________________________________________________________________________________

7. What could the committee do to make the program more effective?

_______________________________________________________________________________________________________________________