This free survey is powered by
  1. Surveys
  2. 2013
  3. November
  4. W
  5. WELLife
0%
Exit Survey
 
 
Hello:
You are invited to participate in our survey to determine the needs of the teachers of the Brooking's School District in regards to a health program. Questions will be asked about overall health and wellness. It will take approximately 10-20 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Elizabeth Sittig at 555-555-5555.

In order to have your name included in the drawing, your name will be asked to be entered separately from the survey as to keep your responses anonymous.

Please submit the survey by September 8, 2013 by 11:59 pm Central Time.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.
 
 
 
On an average day, how many servings of fruits do you consume daily?
 
0-2
 
3-4
 
5 or more
 
 
 
On an average day, how many servings of vegetables do you consume daily?
 
0-2
 
3-4
 
5 or more
 
 
 
On an average day, how much water do you drink? (1 glass represents 8 ounces)
 
0-2 glasses
 
3-5 glasses
 
6-8 glasses
 
9 or more glasses
 
 
 
During a typical week, how often do you eat outside of the home?
 
Never
 
Once a week
 
2-4 times a week
 
5-6 times a week
 
7 times a week
 
 
 
In a typical week, how many days do you exercise?
 
I don't regularly exercise
 
Once a week
 
2 to 4 days a week
 
5 to 7 days a week
 
 
 
Typically, how long is the duration of your workout?
 
Not sure
 
0-30 minutes
 
30-60 minutes
 
60 or more minutes
 
I don't work out
 
 
 
In a typical week, how often do you feel stressed at work?
 
Always
 
Most of the time
 
About half of the time
 
Once in a while
 
Never
 
 
 
In a typical week, how often do you engage in stress relief activities?
 
At least once a day
 
A few times a week
 
Once a week
 
Never
 
 
 
What type of stress relief activities do you engage in?
 
Exercise
 
Yoga or Meditation
 
Watch T.V. or Listen to Music
 
Read
 
Power Nap
 
Visualization Exercises
 
I don't engage in stress relief activities
 
Other (please specify)