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					                                                                                                                employee survey • 1




    employee survey




             employee survey
Introduction                                                           If you agree to complete the survey please tick this box

Welcome to the Get moving at Work
health and wellbeing survey.
                                                                       General
This survey asks you about eating, physical activity,
alcohol consumption, smoking habits and stress and will
take you approximately 5 minutes to complete.                               Age:                                               years

                                                                            sex: (please circle)           Male               Female
This information will be used to provide a report on the
health and wellbeing of your organisation. This report                      Height: (estimate)	            cms or              ft/in
will include no individual information. The general report
will help your organisation identify changes that it can                    Weight: (estimate)             kgs or              lbs
make to the workplace to support improved health and
wellbeing.

As the developers of this survey, the Premier’s Physical               Smoking
Activity Council takes your confidentiality very seriously.
The following steps have been put in place to ensure your
                                                                       1.      Do you smoke?
confidentiality:

                                                                       >           No (Go to question 2)
The survey does not request your name, email
                                                                       >           Yes
address or postal address.
                                                                       1a. How keen are you to stop smoking (please	circle)?
All information collected will be treated as private
and confidential, in accordance with current privacy
                                                                       0	=	not	keen	at	all	/	7	=	very	keen
legislation.
                                                                       0      1      2        3       4    5        6     7

No group information which could be used to identify
                                                                           1b. When you wake up each day, how soon do you
individual respondents will be provided to your
                                                                               smoke your first cigarette?
organisation.

                                                                       >           More than 60 minutes (0)
The non-identifiable information collected through this
                                                                       >           31-60 minutes (1)
survey may be used by the Premier’s Physical Activity
                                                                       >           5-30 minutes (2)
Council for reserach purposes in the future.
                                                                       >           Less than 5 minutes (3)

Disclaimer
                                                                       1c. How many cigarettes do you smoke on a
The	 information	 provided	 is	 for	 general	 information	 purposes	       typical day?
only.		It	is	not	nor	should	it	be	relied	upon	as	an	alternative	to	
professional	medical	advice.                                           >           10 or less (0)
                                                                       >           11 to 20 (1)
This	version	of	this	suvey	was	updated	on	7	July	2011.
                                                                       >           21 to 30 (2)
                                                                       >           More than 30 (3)
2 • employee survey




     employee survey




Nutrition                                                             5.    DurING WorK Hours, how many days of the
                                                                            week do you usually eat foods that are high in fat,
                                                                            salt or sugar (such as deep fried foods, hot chips,
r	 1	serve	of	fruit = a medium sized apple/orange/                          pies, pastries, chocolates, lollies, crisps etc)?
   banana, 2 apricots/kiwi fruit or 1/2 cup tinned fruit
r	 1	serve	of	vegetable = 1/2 cup cooked vegetables or 1              >     None (0)
   cup salad vegetables                                               >     One day (1)
                                                                      >     Two days (2)
2.   How many serves of vegetables (including fresh,                  >     Three days (3)
     frozen and tinned vegetables) do you usually eat                 >     Four days (4)
     each day?                                                        >     Five days (5)
                                                                      >     Six days (6)
¢>   One serve (1)                                                    >     Seven days (7)
>    Two serves (2)
>	   Three serves (3)                                                 6.    Why do you usually choose fast food instead of
ì>   Four serves (4)                                                        something you prepared yourself? (please tick all
>    Five serves (5)                                                        that apply)
>    Six or more serves (6)
>    Don’t eat vegetables (0)                                         >                  I never eat/drink fast food
                                                                      >						 Cheaper
3.   How many serves of fruit (including fresh, frozen                 >                 More convenient
     and tinned fruit) do you eat each day?                              >               Tastes better/good
                                                                           >             Availability
>    One serve or less (1)                                                   >           The hours I work
>    Two serves (2)                                                            >         Makes me feel better when I am stressed
>    Three or more serves (3)                                                    >       I don’t know how to prepare a healthy meal to take
>    Don’t eat fruit (0)                                                                 to work
                                                                      	            >     Access to vending machines
4.   How many days of the week do you usually eat junk                               >   I can not be bothered to bring
     foods that are high in fat, salt or sugar (such as deep                             something healthy from home
     fried foods, hot chips, pies, pastries,chocolates,                                > Lack of access to kitchen/food
     lollies, crisps etc)?                                                               preparation facilities

Do	not	count	days	when	these	foods	make	up	a	small	amount	of	
your	total	food	intake	such	as	a	biscuit	for	morning	tea	or	a	mini	
chocolate	after	lunch.	


>    None (0)
>    One days (1)
>    Two days (2)
>    Three days (3)
>    Four days (4)
>    Five days (5)
>    Six days (6)
>    Seven days (7)
                                                                                                          employee survey • 3




         employee survey




Hydration                                                         Physical Activity

7.       on average, during your normal WorKING DAy,              13. How many times a week do you usually do:
         how many glasses (250ml) of fluid (water, cordial,
         soft drink, juice, milk, coffee, tea) do you consume?	   (a) 20	minutes	or	more	of	vigorous-intensity	physical	
         (please	circle	one)                                          activity	that	makes	you	sweat	or	puff	and	pant	(for	
                                                                      example,		heavy	lifting,	digging	or	jogging)?
    1      2        3    4       5      6    7      8+            0     1       2     3       4      5       6      7+ times

    8.   on average, during your normal WorKING DAy, how              (b) 30	minutes	or	more	of	walking	(for	example,	walking	
         many glasses (250ml) of plain drinking water do you              from	place	to	place	for	exercise	or	recreation)?
         consume? (please	circle	one)                                 0     1      2      3       4      5       6      7+ times

    1      2        3    4       5      6    7      8+            Three	10	minute	sessions	(or	two	15	minute	sessions)	count	as	one	
                                                                  30	minute	session.

Alcohol                                                           (c) 30	minutes	or	more	of	other	moderate-intensity	
                                                                      physical	activity	that	increases	your	heart	rate	or	
9.       Do you drink alcohol at all?                                 makes	you	breathe	harder	than	normal	(for	example,	
                                                                      carrying	light	loads,	slow	cycling)?
>        No                                                       0     1       2      3       4      5      6      7+ times
>        Yes
                                                                      14. How much of your total activity occurs in work time?
                                                                          (Work time does include travelling to and from
10. How many days of the week do you drink?                               work.)


>        1-4 days                                                 >       None
>        5-7 days                                                 >       Some
                                                                  >       Most
                                                                  >       All
11. How many standard drinks (see attached standard
    drinks guide) do you have on a typical day when you           15. Indicate reasons why you think you are NoT being
    are drinking?                                                     more physically active during work hours (please	tick	
                                                                      all	that	apply)
>        1 or 2 (0)
>        3 or or more                                             >       Too tired
                                                                  >       Not enough time
12. on any single occasion do you ever consume 5 or               >       Lack of facilities
    more standard drinks?                                         >       Shift work, especially nights or overtime
                                                                  >       Out on the road most of the time
         No                                                       >       Not encouraged to
>
         Yes                                                      >       No shower facilities
>
                                                                  >       Not motivated
                                                                  >       Not enough flexible time in work hours
                                                                  >       Health issues
                                                                  >       I am already active enough
4 • employee survey




      employee survey




Wellbeing

16. The next ten questions are about how you have been feeling in the past four weeks.

                                                                (1)        (2)         (3)        (4)         (5)
                                                                None	of		 A	little	of	 Some	of	   Most	of	    All	of
	                                                               the	time		 the	time	 the	time	    the	time	   the	time

    In the past four week, about how often did you feel tired
    out for no good reason?

    In the past four weeks, about how often did you feel
    nervous?

    In the past four weeks, about how often did you feel so
    nervous that nothing could calm you down?

    In the past four weeks, about how oftne did you feel
    hopeless?

    In the past four weeks, about how oftne did you feel
    restless or fidgety?

    In the past four weeks, about how often did you feel so
    restless you could not sit still?

    In the past four weeks, about how often did you feel
    depressed?

    In the past four weeks, about how often did you feel
    that everything was an effort?

    In the past four weeks, about how often did you feel
    so sad that nothing could cheer you up?

    In the past four weeks, about how often did you feel
    worthless?
                                                                                                      employee survey • 5




        employee survey




Time Spent Sitting

We would like to know more about the time you spend at your workplace on a typical day.

17. please estimate the number of hours that you spend at your workplace on a typical day. (please circle)

0         1      2      3      4      5      6      7      8     9        more than 9

    18. please estimate the number of hours that you spend sitting at your workplace, including during meal and snack
        breaks on a typical day. (please circle)

    0     1      2      3      4      5      6      7      8     9        more than 9

    19. How many times on a typical day while at your workplace, do you interrupt your sitting? eg by standing up, walking
        somewhere of getting a drink

>       5 times or less
>       6-10 times
>       11-20 times
>       more than 20 times
6 • employee survey




      employee survey




Australian Government Department of Health and Aging alcohol guide: www.alcohol.gov.au


                                       NUMBER OF STANDARD DRINKS – BEER




      1.1               0.8              0.6                 1.6               1.2               0.9                 1.4              1              0.8
       285ml       285ml         285ml                        425ml       425ml         425ml                         375ml       375ml         375ml
   Full Strength Mid Strength Low Strength                Full Strength Mid Strength Low Strength                 Full Strength Mid Strength Low Strength
 4.8% Alc. Vol 3.5% Alc. Vol 2.7% Alc. Vol              4.8% Alc. Vol 3.5% Alc. Vol 2.7% Alc. Vol               4.8% Alc. Vol 3.5% Alc. Vol 2.7% Alc. Vol




       1.4                  1                 0.8                           34                                24                              19
        375ml              375ml             375ml                       24 x 375ml                        24 x 375ml                       24 x 375ml
    Full Strength       Mid Strength      Low Strength                   Full Strength                    Mid Strength                     Low Strength
  4.8% Alc. Vol        3.5% Alc. Vol     2.7% Alc. Vol                 4.8% Alc. Vol                     3.5% Alc. Vol                    2.7% Alc. Vol



 These are only an approximate number of standard drinks. Always read the container for the exact number of standard drinks.



                                       NUMBER OF STANDARD DRINKS – WINE




        1.5                      1                     0.8                     1.4                 0.9
        150ml                  100ml                   60ml                    150ml                100ml
       Average             Standard Serve          Standard Serve             Average          Standard Serve                  1.4
  Restaurant Serving        of Red Wine                of Port           Restaurant Serving    of White Wine                150ml                  7.1
    of Red Wine            13% Alc. Vol           17.5% Alc. Vol          of White Wine        11.5% Alc. Vol         Average Restaurant        750ml
   13% Alc. Vol                                                           11.5% Alc. Vol                             Serve of Champagne Bottle of Champagne
                                                                                                                        12% Alc. Vol       12% Alc. Vol




        7.7                     41                        21                   6.8                     36                        18                28
        750ml                4 Litres                  2 Litres                750ml                 4 Litres                 2 Litres            2 Litres
 Bottle of Red Wine       Cask Red Wine             Cask Red Wine      Bottle of White Wine     Cask White Wine          Cask White Wine        Cask of Port
   13% Alc. Vol           13% Alc. Vol              13% Alc. Vol          11.5% Alc. Vol         11.5% Alc. Vol           11.5% Alc. Vol      17.5% Alc. Vol
These are only an approximate number of standard drinks. Always read the container for the exact number of standard drinks.
                                                                                                                                                employee survey • 7




     employee survey




                                      NUMBER OF STANDARD DRINKS – SPIRITS




                                                    1.1                1.2                2.6                  1.5                1.8                3.6
                                                    275ml              330ml               660ml             275ml               330ml              660ml
         1                    22                Full Strength       Full Strength       Full Strength     High Strength       High Strength      High Strength
       30ml                 700ml                   RTD*                RTD*                RTD*             RTD*                RTD*               RTD*
   High Strength         High Strength         5% Alc. Vol         5% Alc. Vol         5% Alc. Vol        7% Alc. Vol         7% Alc. Vol        7% Alc. Vol
    Spirit Nip          Bottle of Spirits
  40% Alc. Vol          40% Alc. Vol




             1                 1.2               1.5                 1.7              1.4 – 1.9                1.6                2.1                2.4
          250ml               300ml               375ml             440ml                 250ml          300ml                    375ml              440ml
       Full Strength       Full Strength      Full Strength      Full Strength        High Strength   High Strength           High Strength      High Strength
      Pre-mix Spirits     Pre-mix Spirits    Pre-mix Spirits    Pre-mix Spirits       Pre-mix Spirits Pre-mix Spirits         Pre-mix Spirits    Pre-mix Spirits
      5% Alc. Vol         5% Alc. Vol        5% Alc. Vol        5% Alc. Vol         7% – 10% Alc. Vol 7% Alc. Vol             7% Alc. Vol        7% Alc. Vol




                                                                                                                                                                    D0027(1008)
These are only an approximate number of standard drinks. Always read the container for the exact number of standard drinks.                      * Ready-to-Drink

				
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