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* 1. What is your campus location?

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* 2. Which category best describes your position?

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* 3. Which of the following categories best describes your employment status?

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* 4. Please choose the gender you identify with

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* 5. Check your age group (optional)

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* 6. How do you like to receive information about health topics and other wellness-related initiatives and
programs at work? (Mark all that apply.)

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* 7. When thinking about making changes to become healthier, where do you see yourself?

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* 8. Which of the following health topics interest you? (Mark all that apply).

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* 9. Where do you currently participate in physical activity/exercise? (Mark all that apply).

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* 10. What type of physical activity/exercise do you enjoy doing? (Mark all that apply).

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* 11. Of the following types of wellness-related activities, which would you be likely to participate in or take advantage of? (Mark all that apply.)

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* 12. What is the best time of day to participate in wellness-related activities? (Please check only one
answer.)

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* 13. Which of the following incentives would encourage or increase your participation in health promotion activities? (Mark all that apply.)

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* 14. Which of the following are reasons that you might not participate in University-sponsored
wellness-related activities (onsite biometric screenings, wellness campaigns etc)?
(Mark all that apply).

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* 15. Would you be interested in participating in parenting programs/topics that equip you with insights and tools that foster well-being in yourself and your children? Example topic ideas include: Are you over-scheduling your kids; Getting kids to listen without nagging; Are your family's routines working?

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* 16. Do you participate in Farms to Pitt or a related local produce delivery program?

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* 17. If the University of Pittsburgh created a vegetable garden on campus (to promote better nutrition), would you be interested in helping take care of it?

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* 18. If you currently use tobacco products, are you interested in quitting?

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* 19. If you are a tobacco user and are ready to quit, would you be interested in attending an onsite tobacco cessation group class on campus?

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* 20. If the University of Pittsburgh sponsored a 5K race that includes other local universities, would you
participate?

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* 21. Please include any suggestions you may have on workplace wellness in the space below.

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