Well-Powered Worksites Worksite Wellness Survey 2026 1Welcome2Tobacco Free Designation3Physically Active4Well Nourished5Family Friendly6Building Resilience7Diversity, Equity, Inclusion & Belonging8Closing Questions InstagramThis field is for validation purposes and should be left unchanged. Let’s Get Started Hello! Thank you for taking the on-line questionnaire. A few tips: Please complete this questionnaire in one sitting, as answers don’t save. If you come to a question and are unsure of your answer, simply answer “no” and you will have the opportunity to change it when you meet with us to go over your results. Stay awesome – SaraCompany Name:* “Success is the sum of small efforts, repeated day in and day out.” Have a written policy banning tobacco use at your worksite.*This means smoking/tobacco inside the worksite is prohibited. Yes No No, but interested Fully implemented your tobacco use policy.*Have you shared the policy with your employees? Would an employee who was not adhering to the policy be spoken to? Yes No No, but interested Prohibit tobacco use on campus.*This means 100% tobacco free campus. You would answer No if you have a designated smoking area. Yes No No, but interested Prohibit tobacco use in company vehicles.* Yes No No, but interested N/A Display no smoking/tobacco signs inside or outside the worksite.* Yes No No, but interested Prohibit sale of tobacco products on company property.*This is typically an automatic Yes. The question pertains to places like convenience stores and grocery stores. Yes No No, but interested Promote or provide free or subsidized tobacco cessation counseling.*Tip – Many health insurance providers offer this service via an employee portal. Yes No No, but interested Refer tobacco users to a state or other tobacco cessation telephone quit line.* Yes No No, but interested Inform employees about health insurance coverage or programs that include tobacco cessation medication and counseling.* Yes No Provide incentives for being a current non-user of tobacco and for current tobacco users that are currently involved in a cessation class or actively quitting.*Often incentives are provided for those trying to quit, which is great – but we can’t forget about the non-smokers. Do you provide extra breaks for those who don’t smoke? How about beautifying an area outside for non-smokers to enjoy. Yes No No, but interested “That awkward moment when you’re wearing Nike’s – and you can’t do it.”Provide an exercise facility on or off-site.* Yes No No, but interested Subsidize or discount the cost of exercise facilities (on or off-site).* Yes No No, but interested Provide organized individual or group physical activity programs for employees.*Examples: Yoga class, weight training, organized walking program, and/or Right This Way Yes No No, but interested If yes, what type of program(s) are provided?* Right This Way Walking/Hiking Groups Onsite Fitness/Yoga Classes Company Sports Teams (biking, skiing, softball, kickball) OTHER Other Programs*Provide a dedicated space where employees can engage in physical activity.* Yes No No, but interested Provide flexible work scheduling to accommodate physical activity (for positions where flex scheduling wouldn't disrupt business services).* Yes – most employees Yes – some employees No No, but interested Provide environmental supports for recreation or physical activity.*Examples: Bike racks, showers, walking maps, free weights, pickle ball set, etc. Yes No No, but interested Have a written physical activity policy.*Your policy may not be called “physical activity”, but do you have policies that make it easier to be physically active at work, i.e. walking meetings, casual dress code, flex time? Yes No No, but interested Fully implemented your physical activity policy.*Have you shared the policy with your employees? Do managers encourage and role model the behaviors? Yes No No, but interested Encourage employees to use the stairs by posting signs or making stairwell entrances more inviting.* Yes No No, but interested N/A Provide resources on the benefits of physical activity via videos, posters, pamphlets and/or newsletters.*That’s a big Yes is you offered Right This Way at your organization and/or distribute the Well Balanced Newsletter! Yes No No, but interested Provide learning opportunities on the benefits of physical activity via educational seminars, workshops or classes.* Yes No No, but interested “Spread love as thick as you would Nutella.”Provide employees with food preparation and storage facilities.* Yes No No, but interested Offer an on-site farmers' market, or promote one that is nearby.* Yes No No, but interested Have a written policy or formal communication which makes healthier food and beverage choices available during employer sponsored functions.*A “formal communication” could be an email or announcement from leadership. Yes No No, but interested Fully implemented your healthy food and beverage policy or formal communication.*When employees attend a meeting or employer sponsored function, will they find healthy options? Are actions taken to correct if necessary? Yes No No, but interested Provide free filtered water to employees all day.* Yes No No, but interested Promote healthy food initiatives.*Examples: fresh fruit Fridays, salad clubs, healthy potlucks, reduce cost of healthy food, etc. Yes No No, but interested Provide resources on nutrition via videos, posters, pamphlets and/or newsletters.*Did you offer Right This Way and/or distribute the Well Balanced Newsletter – that’s a Yes! Yes No No, but interested Provide learning opportunities on nutrition via educational seminars, workshops, or classes.*Your health insurance provider may offer this service via an employee portal. Yes No No, but interested The remaining questions apply to vending machines, cafeterias or snack stations. Do you have any of these at your worksite?* Yes No Have a written policy or formal communication on healthy vending.*The “formal communication” could be the vendor contract if it states healthy options will be made available. Yes No No, but interested N/A Fully implemented your written policy or formal communication on healthy vending.*Is the vending machine monitored to ensure healthy options are stocked? Are actions taken to correct if necessary? Yes No No, but interested N/A Have a written policy or formal communication offering at least 50% healthy options in cafeteria and/or snack station.*The formal communication could be an email, announcement or part of the department’s standard operating procedures. Yes No No, but interested N/A Fully implemented your written policy or formal communication offering at least 50% healthy options in cafeteria and/or snack station.* Yes No No, but interested N/A “Find your tribe. Love them hard.”Have a written family friendly policy.*Topics covered in policy may include: breastfeeding, babies at work, shift swapping, telecommute, etc. Yes No No, but interested Fully implemented your family friendly policy.*Have you shared the policy with your employees? Does leadership actively support the policy (i.e. making it easy for nursing moms to take a break) Yes No No, but interested Provide flexible scheduling to care for family members.*Examples: take a parent to the doctor, dog to the vet, allow moms to pump breast milk, etc. Yes No No, but interested Provide a private space (other than a restroom) that may be used by an employee to pump breast milk.* Yes No No, but interested Offer paid maternity and/or paternity leave, separate from any other accrued leave / PTO.*You would answer No if the leave is through short term disability that the employee pays for. Yes – Maternity Yes – Maternity & Paternity No No, but interested Provide family friendly resources via videos, posters, pamphlets and/or newsletters.*Topic examples: child or elder care, respite services, breastfeeding, after school programs, etc. Yes No No, but interested Promote breastfeeding support groups or educational classes.* Yes No No, but interested Provide employees paid sick days that may also be used to accommodate family member care.* Yes – Full Time Yes – Full Time & Part Time No No, but interested Provide work-life balance/life-skills programs.*Examples: subsidized child care, tuition reimbursement, employee assistance program (EAP),etc. Yes No If yes, what program(s)?* Employee Assistance Program Tuition Reimbursement/Student Loan Payback Onsite Child Care Onsite Counselor OTHER Other Programs*Extend organizational health programs to family members.*Examples: flu clinic Yes No If yes, what program(s)?* Flu Shots Wellness Programs Biometric Screens Use of Employee Garden OTHER Other Programs*Provide all permanent full-time and part-time employees with a living wage.*$14.99/hr., $31,175/yr. without insurance; $13.69/hr., $28,475/yr. with insurance. Yes No No, but interested “The two most important days in life are the day you were born and the day you find out why.”Provide employees paid vacation/personal days.* Yes – Full Time Yes – Full Time & Part Time No No, but interested Provide employees with paid time for volunteer/community service opportunities.* Yes – most employees Yes – some employees No No, but interested Have a mental wellness policy.*You would answer Yes here if you have any policies that support employees’ mental health, substance misuse recovery and stress management. If your substance misuse policy only outlines disciplinary actions, you would answer No here. Yes No No, but interested Fully implemented your mental wellness policy.*Have you shared the policy with your employees? Do managers know their role in carrying out the policy? Yes No No, but interested Refer employees with alcohol or drug problems to local substance misuse treatment services and resources.* Yes – process in place Yes – hasn’t occurred, but would allow No No, but interested Offer flextime from work to employees seeking mental health or substance misuse treatment.* Yes – process in place Yes – hasn’t occurred, but would allow No No, but interested Provide training for managers on identifying and reducing workplace stress-related or depression issues.*Your health insurance provider may offer this service via an employee portal. Yes No No, but interested Provide environmental supports to manage stress.*Examples: animals in the workplace, mindfulness bell, biophilic design elements – bringing nature inside via plants and other natural elements. Yes No No, but interested Provide training for managers on substance misuse in the workplace.* Yes No No, but interested Provide resources on depression, substance misuse and/or stress management via videos, posters, pamphlets, newsletters.* Yes No No, but interested Provide learning opportunities on depression, substance misuse and/or stress management via a series of educational seminars, workshops, or classes.* Yes No No, but interested Diversity, Equity, Inclusion& Belonging Section*Implementing DEIB initiatives in the workplace can be a complex process, and each organization’s DEIB journey is unique. To aid you in this process, we have added the following DEIB section to this assessment utilizing the Myer DEI Spectrum Tool (2018). I would like to answer DEIB questions I prefer to skip this section Implementing DEIB initiatives in the workplace can be a complex process, and each organization’s DEIB journey is unique. To aid you in this process, we have added the following DEIB section to this assessment utilizing the Myer DEI Spectrum Tool (2018). The scale focuses along the DEI continuum – Not Yet Started, Ready to Start, Launched, Well on the Way, and Exemplary/Leading. Please Note: Few organizations’ DEIB experiences will fit neatly into these stages. The descriptions of organizational characteristics at each point in the process are intended to serve as guideposts rather than fixed stages. Select the circle under each category that best describes where you believe your organization falls. Not Yet Started Ready to Start Launched Well on the Way Exemplary/Leading DEIB Vision*Does not see DElB as relevant to its workRecognizes the importance of DElB to its work and is contemplating its next stepsRecognizes the importance of DElB to its work and is in the process of developing a shared DElB visionHas developed a shared DEIB vision and is working to align the organization’s programs and operations with this visionHas integrated DElB in organizational mission and vision statements which are actively being used to guide the organization’s programs and operationsCommitment*Does not have an interest in advancing its DElB workIs interested in advancing its DElB work and is considering how to do soIs interested in advancing its DElB work and has put some strategy or actions in motionIs actively engaged in its DEIB workA commitment to DEIB is fully institutionalized throughout the organization both internally and externally.Leadership*Members of management, staff or board have not taken leadership on DEIB issuesA few members of management, staff of board are leaning the DEIB discussionA DEIB point person or team is leading the organization’s DEIB workAll levels of management, staff and board are taking leadership on DEIB issuesOrganization is a DEIB leader and is helping to build the field and best practices; leadership demonstrated accountability to clients, costituents and stakeholdersPolicies*Does not have any DElB-related organizational policies (beyond non-discrimination policies)Does not have, but is interested in developing DEIB-related organizational policies (beyond non-discrimination policies)May have some DEIB-related language in some of its organizational policiesHas DEIB policies and/or organizational DEIB plan but may be unclear about how to operationalize itHas DEIB policies and an organizational DEIB plan with clear goals, strategies and indicators of progress Not Yet Started Ready to Start Launched Well on the Way Exemplary/Leading Infrastructure*Has not had internal discussions about the organization’s DEIB workHas had some limited internal discussions, but doesn’t have an infrastructure guide to the organization’s DEIB workIndividuals or small groups are giving internal DEIB discussions, but aren’t integrated into the organization as a wholeHas internal committees, affinity groups or other formal structures focused on integrating DEIB issues into the organization’s workWork on DEIB issues is integrated into every aspect of organizational culture and infrastructureTraining*Has not done any training related to DEIBIs contemplating doing organizational DEIB training; individual staff may have done some initial trainingSome staff or board have participated in DEIB-related trainingAll management, staff and board are involved in DEIB training and capacity buildingFosters ongoing DEIB training, growth and leadership among management, staff and board in line with an equity plan/strategy; staff are held accountable to DEIB-related practicesDiversity*Doesn’t see diversification of board and staff as a priority; may be paralyzed by the perceived challenges or view it as unattainableHas had initial discussions about and values the idea of diversifying its board and staffBeginning attempts to diversify its board and/or staff but may not know how to do it effectively or have strategies and systems in place; may not result in growing diversityActively works to increase diversity of board and staff, resulting in growing diversity; has begun to identify and institute retention strategies to diversify staffHas policies and strategies for strengthening and maintaining organizational diversity; staff and board represent the diversity of the community it serves; effective retention strategies are implementedData*Does not collect demographic data in its programmatic or operational workDoes not collect demographic data in its programmatic or operational work, but views this as a future goalCollects some demographic data in its programmatic or operational work, but not in a systematic or comprehensive wayCollects and disaggregates comprehensive demographic data in its programmatic and operational work but may not know what to do with the informationRoutinely collects, disaggregates and analyzes demographic data for all programmatic and operational work; uses the information in planning and decision-making. Not Yet Started Ready to Start Launched Well on the Way Exemplary/Leading Community*Doesn’t express interest in building stronger partnerships with communities facing disparities; may see it as unrealistic or unimportant to the organization’s missionValues the idea of building partnerships with communities facing disparities, but may not know how or have relationships to draw uponIs beginning to build partnerships with communities facing disparities, but has not yet established accountability to and meaningful partnerships with these communities and may approach it in a tokenistic wayActively works to build partnerships and trust with communities facing disparities; working to understand how to provide value and support to these communitiesHas strong, mutually beneficial, accountable and equitable partnerships with diverse organizations and leaders from communities facing disparitiesDecisions*DEIB considerations do not factor into decision makingInterested in factoring DEIB considerations into decision making, but may view it as an option or an add-on to core decision-making considerationsDecisions are occasionally influenced by DEIB considerations in an ad hoc wayDecisions regarding organizational policies, practices and resource allocation are informed by DEIB considerationsDecisions regarding organizational policies, practices and resource allocation are systematically guided by DEIB considerationsAccountability*DEIB-related metrics are not included in evaluations of staff or programs or in organizational accountability mechanismsMay recognize the value of including DEIB-related metrics in evaluations of staff or programs in organizational accountability mechanisms, but has not made any plans to do soIs preparing to include or is currently including DEIB-related metrics in a few aspects of the organization, such as staff and/or board representation or evaluation of specific projectsSome of the organization’s standard evaluation and accountability mechanisms include DEIB-related metricsAll evaluations and accountability mechanisms for the organization, its projects, programs, management, staff and board include specific DEIB-related metricsInclusion*No explicit effort is made to create an inclusive atmosphere for staff and board members from communities facing disparitiesValues the idea of being an inclusive organization but tries to achieve this by encouraging staff and board members from communities facing disparities to participate in the dominant cultureThere is an appreciation of the voice and perspective of staff and board members from communities facing disparities, particularly in relation to the organization’s DEIB work, but they are still expected to conform to the dominant cultureThe voice of staff and board members from communities facing disparities is valued and is integrated into aspects of the organization; the organization is in transition from a dominant culture to an inclusive/multicultural cultureAll staff and board feel values and all aspects of the organization reflect the voice, contributions and interests or a multicultural constituency; the organization has transitioned to an inclusive/multicultural culture and has created systems, policies and practices to maintain this culture Just a few additional questions before you’re done!Number of Employees*How many part time employees do you have? (optional)What percentage of your employees currently work remotely either full-time or part-time?*Do you offer health insurance to your employees?* Yes – Full Time & Part Time Yes – Full Time No Do you have a wellness committee?* Yes No 2026 Commitment: My organization is committed to partnering with our worksite wellness advisor over the next 12 months.*Your typed name below will serve as your signature. Did we miss anything in the assessment that you would like highlighted in your Employee Value Proposition (EVP) report? Here is your opportunity to brag about your organization's 2026 accomplishments 🙂The information you provide will help build your organization’s EVP report, so the more detailed information- the more robust your report will become!Thank you for filling out our questionnaire! Please click the button below to submit.