Gold Application

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Important Notes The activities described in your application should have taken place within the last 12 months.

Activities may be repeated for up to two (2) topics/requirements only.

Policies may be used for multiple topics/requirements.

Please do not submit any private or identifying information such as photos or names of employees who participated in activities, without proof of their consent (it may therefore be necessary to redact some of the information contained in evidence)

You can save and continue your application by clicking on the Save & Continue button at the bottom of the form. You will receive a link that is valid FOR 30 DAYS ONLY. Please enter your email to have the link sent to you – we cannot retrieve any partial entries on your behalf.

BUSINESS INFORMATION

Business Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Person(Required)

Phone(Required)

Email(Required)

Website

Healthy Workplace Information

1. Choose FOUR (4) wellness topics that you have focused on throughout the year.(Required)

2. Based on your wellness topic, provide evidence of the following health promotion strategies:

Promotion/Awareness Raising Activities(Required)

Education and/or Skill Building Activities(Required)

Environmental/Administration Support Activities(Required)

Please provide evidence in the form of pictures, screenshots, electronic documents, or other proof for at least ONE activity or measure that was used by your organization the above health promotion strategies:

Accepted file types: pdf, jpg, doc, png, Max. file size: 300 MB.

3. Provide evidence of evaluation you completed for THREE (3) of the activities you listed in the section above(Required)

Please provide evidence in the form of pictures, screenshots, electronic documents, or other proof for at least ONE evidence of evaluation that was used by your organization to commit to wellness:

Accepted file types: pdf, jpg, doc, png, Max. file size: 300 MB.

4. Supportive policy requirements:(Required)

Provide TWO (2) Formal Supportive Policies

ONE (1) Informal Supportive Policy

ONE (1) Comprehensive Workplace Wellness Policy

Please provide evidence in the form of pictures, screenshots, electronic documents, or other proof for at least ONE evidence of evaluation that was used by your organization to commit to wellness:

Accepted file types: pdf, jpg, doc, png, Max. file size: 300 MB.

5. WELLNESS STATEMENT SUBMISSION(Required)

ONE (1) statement of employer’s commitment to wellness.

Please provide evidence in the form of pictures, screenshots, electronic documents, or other proof for at least ONE evidence of evaluation that was used by your organization to commit to wellness:

Accepted file types: pdf, jpg, doc, png, Max. file size: 300 MB.