Needs Assessment Survey On-Campus Wellness Program

Please take a few minutes to answer the questions in this survey regarding on campus wellness programs.  This survey is for you, so answer as comprehensively and creatively as possible.  No name is required for confidentiality and the results of this survey will be used to better provide wellness programs for your department.


Name (optional):

Employment Status (select one):  Full-time

What types of wellness/fitness based issues would you like to more information about?
Example:  Stress management, time management, physical fitness, proper nutrition, yoga, Pilates, etc.:

What avenues of communication would be best for you to receive this information? (select all that apply)

Classroom Phone Handouts


E-mail Website

One on One


What type of recreational activity do you currently enjoy?  Example:  Gardening, walking the dog, playing with kids, exercising, camping, hiking, etc.:

What type of recreational activity would you like to see available at Columbus State?

How many days a week do you participate in some sort of physical/recreational activity?  Example:  Exercising, running, playing a sport, walking, other:

How many days a week would you like to spend doing any of the above mentioned activities?

Do you have currently a consistent exercise routine?  If yes, what does it consist of?