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Employee Wellness Form

Employee Wellness Form – A document used to collect information about an employee’s health, lifestyle, and well-being to support workplace wellness programs and promote a healthy work environment.

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Employee Wellness Form - User Guide

Overview

The Employee Wellness Form is designed to help you assess and communicate your current health status, lifestyle habits, and wellness goals. This information helps your employer understand how to better support your wellbeing in the workplace.

How to Use the Form

1. Filling Out the Form

  • Personal Information Section: Enter your full name, employee ID, department, today's date, and contact number.
  • Health Assessment: Answer questions about current health concerns, medications, and allergies. Be as specific as possible in the details sections.
  • Lifestyle Information: Provide information about your sleep quality, physical activity, stress levels, smoking habits, and water intake.
  • Work Environment: Share your perspective on work-life balance, workspace ergonomics, and break habits.
  • Wellness Goals: Select areas you'd like to improve and specify what support would help you achieve these goals.
  • Acknowledgement: Provide your signature and date to confirm the information is accurate.

2. Form Features

  • Responsive Design: The form works on both desktop and mobile devices.
  • Print Functionality: Use the "Print Form" button to generate a printer-friendly version.
  • Conditional Fields: Some text areas appear based on your previous selections (e.g., "If yes, please specify" fields).

3. Printing the Form

  • Click the "Print Form" button at the bottom of the page.
  • The print version will remove unnecessary elements and optimize the layout for paper.
  • Use your browser's print dialog to select your printer or save as PDF.

Tips for Completion

  • Be honest and thorough in your responses to get the most benefit from the wellness program.
  • If you're unsure about any medical information, consult with your healthcare provider.
  • This form is designed to help your employer support your wellbeing - your responses will be kept confidential.

Technical Requirements

  • The form works in all modern web browsers.
  • JavaScript must be enabled for the print functionality.
  • For date fields, use your browser's date picker or enter dates in YYYY-MM-DD format.

Data Privacy

  • Your wellness information is confidential and will be handled according to your company's privacy policy.
  • Only authorized personnel will have access to your completed form.

If you have any questions or need assistance completing the form, please contact your HR department.

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