WHP Survey Form

Health.Nutrition Consultancy
Workplace Health Promotion Survey Form
As part of the company’s effort to improve the health and wellness of our staff, we are conduction this survey to help us gauge the interest on Workplace health related programmes. Your input is valuable in helping us to plan a workplace health promotion programme for the company.

Gender

Male

Female

Age group:

Pioneers (born 1930-1945, age 66 to 81)

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

Gen X (born 1955-1977, 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

Do you smoke?

Yes

No

Assessments (You may choose more than one)

Basic Health Screening

Lifestyle and Health Assessment

Psychological Assessment

Fitness Assessment – Step Test

Body Test for Fat-n-Muscle

Oral Health Screening

Talks/Workshops (You may tick more than one)
Mental Wellness

Talks/Workshops (You may tick more than one)
Nutrition

Physical Activity (You may tick more than one)

Programmes/Campaigns

Equipment