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  Welcome to the Governor's Worksite Wellness Award Application. The Worksite Wellness Award is designed to honor worksites that have policies, programs, and the infrastructure to support and promote healthy practices. The Governor's Council on Physical Fitness and Health has initiated the Worksite Wellness Award to recognize and celebrate worksites that place a high value on employee health and have taken steps to create and maintain a healthy work environment.

The award is based on criteria that have proven to be effective in promoting and encouraging healthy lifestyles. All of the questions are assigned point values. There are baseline questions that are required of all applicants, along with additional questions that are not required, but add points to the applicant total. The total number of points determines the award level, with different levels being set for small, medium and large businesses.

The award criteria also match with material from the Wisconsin Worksite Wellness Resource Kit and applicants that have not used the kit are encouraged to download or order the kit to create or expand healthy practices in their worksite. You can download or order a copy of WI Worksite WellnessResource Kit at: http://dhfs.wisconsin.gov/health/physicalactivity/Sites/Worksitekit.htm

Thank you for taking the time to complete the award application - another indication of your efforts to promote healthy behavior in your worksite.

   
  Governor's Worksite Wellness Award Application – Key Instructions

1. The Application Will Time Out after 1 Hour.
This application tool has a “time-out” setting of one (1) hour, which is activated when you open the application and reset each time that you move to the next “Page”. If you are inactive in the application for more than an hour, it will "time out".

2. Saving Your Work. Because of the timeout setting, you must move at least to the next “Page” or finish the application within 1 hour for your work to be saved (there are several "pages" in the application, that break up each of the sections). When you move to the next page the clock is reset for 1 additional hour. (When you select “Next” at the bottom of each page or “Done” at the end of the application, your work to that point is also saved).

3. Coming Back To Your Application Answers. If you can’t finish the application in one sitting, you can select “Next” or “Done”, exit the application, and then you can return at a later time to edit or add to your saved responses. (Make sure that you finish a “Page” or section before leaving the application if you’re going to be away for over an hour. You can return to your application by clicking on the original hyperlink on the Governor's Council website - you will have to access the partially completed survey from the same computer).

4. Sending Attachments. You will be asked to send two required attachments separate from the online application: Question #9 - Administrative endorsement and Question #14 Mission Statement and/or Action Plan.
Please send these attachments via email to Jon Morgan at jonathon.morgan@wi.gov
This information will also be listed at the end of the application. You may want to print this instruction page to help you with the application process.


   
  Organizational Information
   
1.
 
   
2.
Must be a Wisconsin-based worksite
 
   
3.
 

    
   
4.
List the most appropriate category.
 

    
   
5.
(Note: Size of business based on total employees, regardless of number of sites)
 
   
6.
There are tiered levels for the award that are based on company size. Number of employees is based on total employees, regardless of number of sites)
Select no more than 2.
 

    
   
7.
 
   
8.
 

 

 

 
   
 
 
 
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