TEST Workplace Health Promotion Survey Form

Dear Colleagues, as part of Mercatus's effort to improve the health and wellness of our staff, we are conducting this quick survey to help to gauge the interest on Workplace health related programmes. Your input is valuable in helping to plan a workplace health promotion programme for the organization. Appreciate you can complete this survey by 15 November 2013, Friday. Thank you very much for your contribution.

Continue button below.

* First :
* Last Name :

* Do you smoke?

Yes

No

* Age Group

Baby Boomers (born 1946-1964, age 47 to 65)

Gen X (born 1965-1977, age 34 to 46)

Gen Y (born 1978-1990, age 21 to 33)

Millennials (born after 1990, age <21)

* Body Mass Index (BMI) : Weight / (Height X Height)

Below & 18.5 Underweight, Risk of nutritional deficiency

18.5 - 22.9 Normal, Low Risk

23.0 - 27.4 Overweight, Moderate Risk

27.5 & above Obese, High Risk

Wish list for Health Assessments (You may select more than ONE)

Basic Health Screening

Fitness Assessment - Step Test

Lifestyle and Health Assessment

Oral Health Screening

Psychological Assessment

What type of Talks / Workshops you would like to attend ? (You may tick more than ONE)

Physical Activities / Corporate Events you would like Mercatus to run (You may select more than ONE)

For Women (Under WHP Women Grant)
What type of Education and Empowerment Programmes / Screening are you interested in?

Thank you for participating in this Survey. THIS IS THE LAST QUESTION. If you have further suggestions, you may indicate below. Thanks. END OF SURVEY.