W O R K S IT E W E L L N E S S C O M M IT T E E A C T IO

Email
Phone
Committee Members
Name
7.
8.
9.
10.
11.
12.
OVERALL COMMUNICATION PLAN:
Email
Step #3
Step #2
Strategy #1
Short-term goal:
Step #1
Responsible
Member(s)
Communication
to Employee
Year #: _______
Results (Outcomes)
Phone
Period Ended:___________________
Date of
Implementation
Short-Term Goal(s)—Strategies that focus on Individual/Group Activities and Environmental Changes
Name
1.
2.
3.
4.
5.
6.
MISSION STATEMENT:
Action Plan for Period Beginning: _________________
WORKSITE WELLNESS COMMITTEE ACTION PLAN
Worksite: _______________________________________________________________________________
Committee Name: _______________________________________________________________________
Committee Chairperson: _________________________________________________________________
Program Coordinator: ____________________________________________________________________
Other Chairs:____________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Responsible
Member(s)
Responsible
Member(s)
Communication
to Employee
Communication
to Employee
Step #3
Step #2
Strategy #2
Long-term goal:
Step #1
Step #3
Step #2
Strategy #1
Long-term goal:
Step #1
Responsible
Member(s)
Responsible
Member(s)
Communication
to Employee
Communication
to Employee
Long-Term Goal(s)—Strategies that focus on Policy and/or Environmental Changes
Step #3
Step #2
Strategy #3
Short-term goal:
Step #1
Step #3
Step #2
Strategy #2
Short-term goal:
Step #1
Date of
Implementation
Date of
Implementation
Date of
Implementation
Date of
Implementation
Results (Outcomes)
Results (Outcomes)
Results (Outcomes)
Results (Outcomes)
Responsible
Member(s)
Programs/Activities to discontinue:
Programs/Activities to continue:
Lessons Learned and/or Barriers:
Successes:
Recommendations from the Committee for Year #_______:
Policy & Environmental Survey (committee only):
Employee Satisfaction Survey:
Year-End Evaluation Summary:
Step #3
Step #2
Strategy #3
Long-term goal:
Step #1
Communication
to Employee
Date of
Implementation
Results (Outcomes)