WORKSITE WELLNESS ACTION PLAN |
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| Name of Organization |
{user:display_name} | |||||||
BUY IN |
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| Name of Wellness Program |
{Name of Wellness Program:2} | |||||||
| Who is the Wellness Sponsor? | {Enter Wellness Sponsor\’s name:3} | {Enter the Wellness Sponsor\’s title:11} | ||||||
| Who is the Wellness Champion? |
{Enter Wellness Champion\’s name:4} | {Enter the Wellness Champion\’s title:13} | ||||||
| Who is on the Wellness Committee (include full name, title, and deparment of each Wellness Committee member)? |
{Who is on the Wellness Committee (include full name, title, and department of each Wellness Committee member)?:5:} | |||||||
| What are 3 values/benefits of your Wellness Program? | 1 | {Values/benefits of your Wellness Program #1::6} | {Productivity, specifically:77}{Recruitment and Retention, specifically:79}{Demonstrate Corporate Leadership and Citizenship, specifically:81}{Business Performance and Risk Management, specifically:83}{Culture of Wellbeing, specifically:85} | |||||
| 2 | {Values/benefits of your Wellness Program #2::7} | {Productivity, specifically:78}{Recruitment and Retention, specifically:80}{Demonstrate Corporate Leadership and Citizenship, specifically:82}{Business Performance and Risk Management, specifically:84}{Culture of Wellbeing, specifically:86} | ||||||
| 3 | {Values/benefits of your Wellness Program #3::8} | {Productivity, specifically:20}{Recruitment and Retention, specifically:21}{Demonstrate Corporate Leadership and Citizenship, specifically:16}{Business Performance and Risk Management, specifically:17}{Culture of Wellbeing, specifically:18} | ||||||
ASSESSMENT |
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| Employee Wellness Interests |
1 | {1st Employee Wellness Interests:19} | 2 | {2nd Employee Wellness Interests:23} | 3 | {3rd Employee Wellness Interests:24} | ||
| Employee Health Risks | 1 | {1st Employee Health Risks:27} | 2 | {2nd Employee Health Risks:28} | 3 | {3rd Employee Health Risks:29} | ||
| Total Program Budget/Financial Considerations (include a separate budget document with more detail) |
{Total Program Budget/Financial Considerations (include a separate budget document with more detail):31} | |||||||
| Health Insurance/Cost Implications | {Health Insurance/Cost Implications:32} | |||||||
PLANNING |
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| Top 3 Overall Program Priorities | 1 | {Overall Program Priorities #1:35} | 2 | {Overall Program Priorities #2:36} | 3 | {Overall Program Priorities #3:37} | ||
| Policy/Environmental Support Considerations | 1 | {Policy/Environmental Support Support 1:39} | 2 | {Policy/Environmental Support Support 2:40} | 3 | {Policy/Environmental Support Support 3:41} | ||
| Staffing/Responsibilities | {Staff Responsibilities:87} | |||||||
| Program Rationale (relationship between organizational wellness goals and proposed interventions) |
{Program rationale:45} | |||||||
| GOAL | {Goal:50} | |||||||
| Objective 1 | {Objective 1:59} | |||||||
| {List:60:} | ||||||||
| Objective 2(if applicable) | {Objective 2:63} | |||||||
| {List:64:} | ||||||||
| Objective 3 (if applicable) |
{Objective 3:66} | |||||||
| {List:67:} | ||||||||
EMPLOYER/ COMMUNITY PARTNERSHIPS |
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| {Employer/Community Partnerships:73:} | ||||||||