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WORKSITE WELLNESS ACTION PLAN

Name of
Organization
{user:display_name}

BUY IN

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

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

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

{Employer/Community Partnerships:73:}