Corporate Wellness Program Health Risk Appraisal

Corporate Wellness Program Health Risk Appraisal — Form Fields

This healthcare template includes 10 fields. Assess employee health risks and wellness needs for a workplace wellness program. Free to customize and use on ZenBuild.

• Employee Name (text, required)
• Work Email (email, required)
• Age Range (dropdown selection, required) — options: 18–24, 25–34, 35–44, 45–54, 55–64, 65+
• BMI Category (self-reported) (dropdown selection, required) — options: Underweight, Normal, Overweight, Obese, Unsure
• Current Health Conditions (checkboxes, optional) — options: High Blood Pressure, Diabetes, High Cholesterol, Heart Disease, Asthma, None
• Lifestyle Habits (checkboxes, required) — options: Regular exercise, Balanced diet, Non-smoker, Limited alcohol, 7–9 hrs sleep nightly
• Stress Level at Work (dropdown selection, required) — options: Low, Moderate, High, Very High
• How often do you have a preventive checkup? (dropdown selection, required) — options: Annually, Every 2+ years, Rarely, Never
• What wellness resources would help you most? (long text, optional)
• How would you rate your overall health? (rating, required)