Healthy Workplaces Survey

Name*

First

Last
Business/Organization Name*
Choose which option best describes you:
- I am an HR / Hiring Manager at a Council Bluffs-based employer
- I am a Business Owner of a Council Bluffs-based employer
- I am an Executive at a Council Bluffs-based employer
EAT WELL
What EAT WELL options does your company offer?
(please select all that apply)
- Healthy cafeteria options
- Healthy vending options
- Water access/water filling stations available
- Workplace garden, container garden, edible orchard or landscaping
- Breastfeeding support (e.g. private space)
- Education seminars on healthy eating choices Taste testing/cooking demos
- Food bucks for the farmers market
- Community Supported Agriculture (CSA) drop site
- Onsite food pantry
- Other (please specify)
Other EAT WELL option
Please indicate what EAT WELL options you are interested in learning more about:
(please select all that apply)
- Healthy cafeteria options
- Healthy vending options
- Water access/water filling stations available
- Workplace garden, container garden, edible orchard or landscaping
- Breastfeeding support (e.g. private space)
- Education seminars on healthy eating choices Taste testing/cooking demos
- Food bucks for the farmers market
- Community Supported Agriculture (CSA) drop site
- Onsite food pantry
- Other (please specify)
Other EAT WELL option I'd like to learn about
MOVE MORE
What MOVE MORE options does your company offer?
(please select all that apply)
- Promotion of active commuting
- Bike parking and/or storage
- Bike share/library
- Onsite fitness facilities
- Ongoing fitness programs
- Physical activity social support groups (e.g. buddy system, walking groups etc.)
- Joint-use access or membership discounts to facilities for physical activity
- Places for physical activity (e.g. maps of walking routes, sidewalks/walking paths on site, workout room on site, greenspaces, or company park.)
- Showers and/or changing facilities
- Free or discounted registrations for local fitness events (e.g. 5k, bike rides)
- Other (please specify)
Other MOVE MORE option
Please indicate what MOVE MORE options you are interested in learning more about:
(please select all that apply)
- Promotion of active commuting
- Bike parking and/or storage
- Bike share/library
- Onsite fitness facilities
- Ongoing fitness programs
- Physical activity social support groups (e.g. buddy system, walking groups etc.)
- Joint-use access or membership discounts to facilities for physical activity
- Places for physical activity (e.g. maps of walking routes, sidewalks/walking paths on site, workout room on site, greenspaces, or company park.)
- Showers and/or changing facilities
- Free or discounted registrations for local fitness events (e.g. 5k, bike rides)
- Other (please specify)
Other MOVE MORE option I'd like to learn about
FEEL BETTER
What FEEL BETTER options does your company offer?
(please select all that apply)
- Employee wellness committee that meets regularly
- Indoor and outdoor nicotine-free policies (i.e. cigarette, chewing tobacco and nicotine vaping products) for employees and customers/clients
- Places for social interaction (e.g. greenspace, park, breakroom, common gathering area.)
- Promotion of joining groups (e.g. civic groups, clubs.)
- Promotion of volunteerism in the community
- Flexible work schedules
- Reward programs for participation in health and wellbeing activities
- Other (please specify)
Other FEEL BETTER option
Please indicate what FEEL BETTER options you are interested in learning more about:
(please select all that apply)
- Employee wellness committee that meets regularly
- Indoor and outdoor nicotine-free policies (i.e. cigarette, chewing tobacco and nicotine vaping products) for employees and customers/clients
- Places for social interaction (e.g. greenspace, park, breakroom, common gathering area.)
- Promotion of joining groups (e.g. civic groups, clubs.)
- Promotion of volunteerism in the community
- Flexible work schedules
- Reward programs for participation in health and wellbeing activities
- Other (please specify)
Other FEEL BETTER option I'd like to learn about
Additional comments or ideas about improving health and wellbeing in the Council Bluffs community:
MOVING FORWARD
What day/s of the week work best for you to meet?
check all that apply
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
What time of day is best to meet?
- Morning
- Lunch
Would you like to help lead and plan this Healthy Workplace Collaborative?*
- YES
- NO

EAT WELL

MOVE MORE

FEEL BETTER

MOVING FORWARD

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