Platinum 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 FIVE (5) wellness topics that you have focused on throughout the year.(Required)

2. Based on your wellness topics, 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)

Wellness Topics: Evidence Submission(Required)

Please provide evidence showcasing your organization’s implementation of EACH of the health promotion strategies 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 FOUR (4) 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 FOUR 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 THREE (3) formal supportive policies in total – ONE (1) policy for each of the THREE (3) wellness topics chosen.

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

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

Policy File Submissions(Required)

Please upload evidence demonstrating the implementation of the policies 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.