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Gold Application

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Gold Application

Application form for Healthy Workplace Awards: Gold

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, where you will receive a link to continue your application. 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)

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)

Promotion/Awareness Raising Activities Evidence Submission(Required)

Please provide evidence demonstrating your organization’s implementation of the Promotion/Awareness Raising Activities described above.

Drop files here or

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

Education and/or Skill Building Activities(Required)

Education and/or Skill Building Activities Evidence Submission(Required)

Please provide evidence demonstrating your organization’s implementation of the Education and/or Skill Building Activities discussed above.

Drop files here or

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

Environmental/Administration Support Activities(Required)

Environmental/Administrative Support Activities Evidence Submission(Required)

Please provide evidence demonstrating your organization’s implementation of the Environmental/Administrative Support Activities discussed above.

Drop files here or

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)

Evaluation Evidence Submission(Required)

Please provide evidence of an evaluation method that was used to evaluate THREE of the wellness topics listed above.

Drop files here or

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

4. Supportive policy requirements:(Required)

Provide TWO (2) Formal Supportive Policies

Formal Policies: Evidence Submission(Required)

Please upload evidence demonstrating the implementation of the Formal Policies mentioned above.

Drop files here or

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

Please submit the name of ONE (1) Informal Policy used by your organization that showcases its commitment to workplace wellness.

Informal Policy: Evidence Submission(Required)

Please upload evidence demonstrating the implementation of the Informal Policy mentioned above.

Drop files here or

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

Please submit the name of ONE (1) Comprehensive Workplace Policy used by your organization that showcases its commitment to workplace wellness.

Comprehensive Policy: Evidence Submission(Required)

Please upload evidence demonstrating the implementation of the Comprehensive Policy mentioned above.

Drop files here or

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.