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CITY OF ROSEVILLE WELLNESS PROGRAM 2005 <br />EventlTopic Verification Points <br />HEALTHY LIF'ESTYLE - WORKJ��Ik'�/��ALTH/WELL-BEING <br />DID NOT USE ANY SICK LEAVE THIS TRIMESTER? Payroii signature: ❑❑ <br />I reviewed a self help or self care book, health update, employee ncwslettar and used <br />something from it. on YourHonor: C� <br />llo you consistently watch less fha�i 14 hours of'1'V a week? on YourHonor ❑ <br />1 completed HY "Yartners in Quitting" or other smokingltobacco cessation program. Arogram receipt attached: ❑❑❑ <br />1 am tobacco free. on YourHonor: � <br />Maintain apersonal healthjournal that includes exercise and diet. On YourHonor. Cf <br />Used the nurse linc or did online research rather than an offsce visit on a minor issue? OnYourNOnor. ❑ <br />Accessed EAP. On YourHonor. (.� <br />TOTAL HEALTHY LIFESTYLE - WORK/LIFEIHEALTHlWELL-BEING <br />(11 POSSIBLE) <br />HEALTHY LIFESTYLE - SAFETY <br />Wear seat belt daily On YaurNonor: L� <br />Completed training course other than the OSHA required training (personal safety, defensive <br />Driving, CPR/�'irst Aid, Defibrillator) Registration Form Attached: � l� <br />Do you wear protective gear such as kneepads, helmets etc. when biking, motorcycling, <br />skateboard, inline skating or other sports? On YourNanor.� ❑ <br />T have been if�jury fiee this trimestEr and stretch daily or after every workout. On vourHonor.� ❑ <br />I keep my home secured when I am there and when 1 am not. On YourHonor. Cf <br />I lock my car doors when I am not in it and when I am traveling? On YourHonor. ❑ <br />TOTAL HEALTHY LIFESTYLE - SAFETY f 7 POSSIBLE � <br />PROGRA,MS/ ACTIVITIES <br />Par�icipated in weight management program (i,e. Weight Watchers, LA Wcight Loss). receipt attached ❑❑ <br />Participated in 10,000 Steps Program thru Health Partners. receipt attached L7 <br />Attended health related seminar, workshop, presentation. Presenters Signature: ❑ <br />TOTALPROGRAMSI ACTIVITIES ( 4 POSSIBLE ) <br />EDUCATION <br />Invited a speakeripresenter and organized a lunchtime presentation. (see HR before doing this <br />one). Cammittee ChairSignature: � � <br />Provided a new idea for the Wellness Program that was adopted by the Health & Benefits <br />Committee. (Give ideato HR). Committee Chair Signature: �❑ <br />Provided Health & Benefits emaiflnewslctter information to Communication's Specialist <br />outside ofregular work hours Communication's 5pecralisf Signature: 0 <br />�Purchased health related equipment, videos, books, eta (Xeceipt re�uired, �20 minimum) �,�rtiw a!!xn� u <br />TOTAL EDUCATION (6 POSSIBLE) <br />TI�I P.1f.'`>' `_' f< <br />R�SE5�ILLE 'tr��LLN � �� �� :•ir�T � • i v: � €� r � iCt �St Or�i�`: Tr�-rti�.:f <br />MU�C {��R � R1I�1IRlUITI �f �� C;}�!lt� I{1 � 9FITI��tG � k� Irr�� !YG 1 i��:�M W.i Giii in n ��T.�L� ���� T�: <br />time fo r tnat t�-imester. 69 possibl'e points � <br />Employee Signature: Toda 's Date: <br />Points Approval Signature: <br />