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Fitness Assessment - Gym

Have you been to a gym before? *

How long do you want your gym session to be? *

How many times a week do you prefer going to the gym? *

How many times would you like to go to the gym weekly? *

would you like to do more free weights or machines? *

If you are human, leave this field blank.

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Performance Assessment

Performance assessment, which provides employees with an opportunity to assess their contributions to the organization, that are essential to developing a powerful work team.

I feel the company's expectation of my performance matches what I am capable of offering in return. *

My personal goals have a space in my company and work well with the goals of the group as a whole. *

My current skill level matches the demands of my job *

The company culture suits my personal work style and ethics. *

My managers are competent nd create good work environment. *

I am allowed to do things on my own without interference *

I have regular opportunities at work to improve my personal skills *

I feel committed to my job *

I am punctual to arrive and leave work *

The quality of work I produce is of a high standard *

I can manage my current work load *

I am able to be reliable in my job *

I am able to be adaptable according to the demands of work *

The company provides enough resources and efficient processes to allow me to do my job correctly *

I can get along with my coworkers and they make a good work environment *

My job role is clear and I am always aware of my responsibilities *

There are no problems or discrimination or favoritism in the work place. *

I am being paid fairly for my job *

I do not suffer from health issues that affect my performance at work *

My home/personal/family life is good and does not affect my performance at work *

If you are human, leave this field blank.

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Sleep Assessment

This sleep assessment will test what your sleeping health looks like. People spend 1/3 of their lives sleeping. This is why it is important to ensure that the sleep that you are getting is quality sleep. This assessment covers the DSM-5 diagnostic criteria for insomnia disorder, but should not be used as formal diagnostic tool.

Does your struggles with sleep last you longer than three nights a week? *

Does your struggles with sleep impact your day to day functioning?

When you wake up in the morning (or odd hours of the morning) do you struggle to fall asleep again?

Do you struggle to fall asleep even when you are tired?

Are your issues with sleep related to any other medical, psychological, and substance issues?

If you are human, leave this field blank.

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Lifestyle Assessment

In the last two weeks have you been feeling down, depressed or hopeless?

Yes

No

I don't know

Do you ever feel like you are going to burnout or breakdown?

Do you often get angry?

Do you often get teary or cry?

Do you tend to get overwhelmed by your circumstances in general?

Do you have a support system that you can always rely on?

When you are sick, do you have someone that will take care of you?

Yes

No

I don't know

How many times do you drink alcohol in a week?

Everyday

1-2 Times a week

3-6 Times a week

Only on Occasions

I don't drink

How many cigarettes do you smoke in a day?

Have you lost some one close to you in past year?

Yes

No

I don't know

Do you have a high-stress lifestyle?

Yes

No

I am not sure

Personally, is employee wellness important to you?

Yes

No

I don't know what employee wellness is

How often do you spend time with friends? (People who do not live with you)?

Are you happy with your self-image?

How confident are you in large groups of new people?

Do you feel stress from work is affecting your personal life?

Yes

No

I don't know

If you are human, leave this field blank.

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Fitness Assessment - Home Workout

Have you done exercises at home before? *

How long is your exercise training at home? *

What cardio equipment do you have at home? *

Do you have space to exercise at home besides being outdoors? *

If you are human, leave this field blank.

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Fitness Assesment - Sports

Fitness Assessment - Sports

Would you like a follow a program for a specific sport? *

Would you like a program to help you with a triathlon? *

Would you like a program thats more Cardio or Weights orientated? *

Would you like a program to help you build muscles? *

If you are human, leave this field blank.

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Physical Activity Assessment

A physical examination is a routine test your primary care provider, perform to check your overall health.

How often do you exercise? *

At what intensity do you exercise? *

What types of physical activity? *

How many hours per day do you watch TV? *

How many hours a day do you spend time sitting (including work) ? *

If you are human, leave this field blank.

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Nutrition And Your Weight

Nutrition and your weight

Being happy with your weight is important for your physical as well as emotional health. Our weight is linked closely to our nutrition habits, let's see if our nutrition is supporting our weight.

Are you happy with your weight?

Are you trying to lose weight?

Are you trying to gain weight?

How often do you eat a day?

How much water do you drink in a day?

Do you have fruits everyday?

How often do you eat greasy, fatty, fast food?

How often do you have sugary food or drinks?

How often do you have processed foods?

If you are human, leave this field blank.

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Gut Health

Our gut is important and is responsible for digesting food and absorbing nutrients in our body. Diarrhea, constipation, bloating, nausea and vomiting are common symptoms of gut dysfunction that can affect our lifestyle and make us feel not so great. Let's see how your gut health is.

Are you experiencing any diarrhea? *

Are you experiencing any constipation? *

Are you experiencing any bloating? *

Are you experiencing any nausea *

Are you experiencing any vomiting *

Are you on medication for your gut? *

If you are human, leave this field blank.

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Nutrition and Skin

Our skin is our largest organ and can reflect the lifestyle we lead. Nutrition can play an important role in the health of our skin. Let's take a closer look and see if our nutrition habits are helping or hindering our skin.

How would you describe your skin? *

Do you have acne? *

Are you looking to improve your skin? *

How much water do you drink in a day? *

How often do you have sugary drinks? *

How often do you have dairy? *

How often do you have fruits and vegetables? *

How often do you eat sweets and chocolate? *

If you are human, leave this field blank.

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Nutritional Assessment Dinner

Do you have chicken or fish for dinner? *

Do you have beef or pork for dinner? *

Do you add vegetables to your dinner? If so, how many *

Do you have rice, potatoes or pasta with your dinner? *

Do you have something to drink with your dinner? If so, what drink? *

If you are human, leave this field blank.

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Nutritional Assessment

This assessment will determine what degree your nutritional levels are at. The company wellness application has nutritionists available to talk and answer any questions that you have aout nutrition and healthy eating.

How often do you eat a healthy breakfast? *

On average, how many sweetened drinks do you consume everyday? *

On average how many fruits and vegetables do you consume everyday? *

On average, how many drinks of alcohol do you have each week? *

Do you binge drink on weekends? *

Do you ever eat food in secret? *

Do you ever make an effort to eat healthy? *

Do you feel having access to a nutritionist would benefit you? *

Have you experienced rapid weight loss over the last 6 months? *

How many times a week do you eat take outs? *

If you are human, leave this field blank.

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Nutritional Assessment

This assessment will determine what degree your nutritional levels are at. The company wellness application has nutritionists available to talk and answer any questions that you have aout nutrition and healthy eating.

How often do you eat a healthy breakfast? *

On average, how many sweetened drinks do you consume everyday? *

On average how many fruits and vegetables do you consume everyday? *

On average, how many drinks of alcohol do you have each week? *

Do you binge drink on weekends? *

Do you ever eat food in secret? *

Do you ever make an effort to eat healthy? *

Do you feel having access to a nutritionist would benefit you? *

Have you experienced rapid weight loss over the last 6 months? *

How many times a week do you eat take outs? *

If you are human, leave this field blank.

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Nutritional Assessment Lunch

Do you have chicken or fish for lunch? *

Do you add vegetables to your lunch? If yes, how many? *

Do you have carbohydrates with your lunch? *

Do you have a fruit at lunch? *

If you are human, leave this field blank.

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Investing

Investing is not only a way to make money, but it helps you manage your risk and picks up the slack when interest rates fall.

Do you know where to start with investments? *

How much risk are you comfortable with? *

How do you invest your money *

How often do you check your portfolio? *

If you are human, leave this field blank.

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Debt Review

Debt is a serious issue that many people will face, but there steps you can take to reduce the amount you can take to reduce the amount of debt on your

Do you earn an income? *

How much total debt do you have? *

Do you need help to reduce your debt? *

Are you under debt review? *

What time can you be contacted? *

Have you had any of your accounts handed over? *

Have you received any legal letters on any of your accounts? *

If you are human, leave this field blank.

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Finance Assessment

Financial Assessment is the process of meeting your life goals through the proper management of your finances.

Have you received calls from your creditors? *

Do you skip one accoint to pay another account *

Is it difficult to pay more than the amount due on your account each month? *

Are you unsure of how much debt you have? *

Are you late with your payments from time to time? *

Do you pay your accounts in full each month? *

Have you received letters of demand (section 129 letter)? *

Are you in areas with your cellphone, school fees or municipal debt? *

Are you considering selling assets to enable you to make payments? *

Are you playing lotto in hopes it will solve your debt problems? *

If you are human, leave this field blank.

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Self Esteem Self Assessment

This self-esteem of a human being is the most important thing in their life. You can't be happy if you don't feel good about yourself, and low levels are not sustainable overtime! The below assessment may assist in assessing your self esteem but may not be used to as a diagnostic tool

I usually have a positive view of myself *

I sometimes struggle to acknowledge my own achievements. *

It's easy for me to recognize my good qualities *

I feel like I have to nothing to be proud of. *

I always feel that I am worthy of everything I have and everything I deserve. *

I struggle to respect myself like others do. *

Whenever things do not go right, I often feel like a failure. *

I tend to feel useless when I can't help others. *

I am able to perform the same way as others, or perhaps even better. *

All in all I am completely satisfied with myself. *

If you are human, leave this field blank.

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Obsessive Compulsive Personality Disorder

Have you ever wondered if you have been struggling with any obsessive compulsive behaviors?

Are you preoccupied by details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost? *

Do you struggle to complete a task or participate in activities because your too much of a perfectionist? *

Are you often so preoccupied by work that you struggle to participate in life? *

Do you find yourself being overly consientious about topics involving morals, ethics or values? *

Do you struggle letting go of material objects that hold no value? *

Do you struggle with group projects because other people cannot keep up to the quality of work that you produce? *

Do you have a tendency to hoard money because of a irrational fear of future emergencies? *

If you are human, leave this field blank.

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Sleep Assessment- Excessive Sleep

This sleep assessment will test what your sleeping health looks like. People spend 1/3 of their lives sleeping. This is why it is important to ensure that the sleep you are getting is quality sleep. This assessment covers the DSM-5 diagnostic criteria for hypersomnolence disorder, but should not be used as formal diagnostic tool.

Do you feel sleepy even after a full nights rest? if yes, do you usually fall asleep again? *

Do you sleep more than the recommended 8 hours a night? *

Do you struggle being fully awake after a disrupted sleep? *

Does your struggles with excessive sleep disrupt your day to day functioning (e.g. work, social interaction etc.)? *

Are your struggles with excessive sleep attributed to a medical, psychological, or biological condtion? *

If you are human, leave this field blank.

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ADHD Self Screening Assessment for Adults

There are many reasons why someone might be hyperactive. One possible explanation is that their thought process moves quickly, making it difficult for them to control themselves or think things through before acting on impulse. A person's mood can also change during times of impulsivity which causes them to not only have trouble staying still but may cause physical problems as well-such has fainting due to an increased blood pressure level from excitement about potential dangers around us all the time!

Do you struggle staying in one place at a time, for example, are you usually running for the door after a meeting or making excuses to leave the room? *

Do you struggle giving people the chance to finish their questions or their sentences because you feel like they are taking too long to get to the point? *

Do you often find yourself dominating conversations by talking excessively? *

Do you struggle to engage in activities that require silence, for example, do you struggle keeping quiet when required to? *

Do you find it hard waiting your turn, for example, when waiting in line or waiting for to finish up so that you can use something? *

Do you find yourself budding into other people's conversations for no reason, do you sometimes start activities without permission because you can't wait? *

Do you find yourself fidgeting and squirming in your seat uncontrollably? *

Do you often jump into things or insert yourself into situations where it is inappropriate? *

Have you been told that you are restless , and can't stay for lomng periods of time in places such as restuarants, meetings etc.? *

Do you have a family history of mental health related illness/diagnoses that relate to ADHD? *

If you are human, leave this field blank.

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ADHD Self Screening Assessment for Adults - Inattention

Inattention is a common problem in which people fail to pay attention, either by having their minds wonder or because the task at hand activated an escape response.

Do you often struggle with sustaining your attention and focusing on tasks or activities, such as lectures, workshops, meetings etc.? *

Do you sometimes find yourself making careless mistakes because a lack of focus and attention? *

Does yout mind often wonder during conversations, making you lose focus on what is being said? *

Do you often struggle with instructions or start off strong with activities and tasks, but then eventually fail to complete them because you get sidetracked? *

Do you struggle with organizing and planning out your tasks and activities? *

Do you sometimes avoid or dislike activities and tasks that require any mental effort? *

Do you often lose important things required to complete tasks and activities? *

Are you easily distracted by your environment, do you struggle to focus on one thing at a time? *

Are you often forgetful, do you struggle recaling events or important tasks? *

Do you mostly experience the above symptoms in addition to other symptomsm relating to other mental health issues? *

If you are human, leave this field blank.

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Stress Assessment

Stress is a necessary part of our lives and can have both beneficial and negative effects. The stress response is primarily determined by our perception of an event, transition, or problem.

Do you suffer from any of these external causes of stress? *

When you are stressed, which of these physical symptoms do you suffer from? *

What are things that stress you out? *

Do you suffer from any of the following that you have not disclosed to management? *

If you are human, leave this field blank.

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Presenteeism Assessment

The practice of being present at one's place of work for more hours than is required, especially as a manifestation of insecurity about one's job.

Have you had a work-related injury in the past year? *

Do you find yourself working overtime? *

Have you missed work due to mental health in the last 6 months? *

Can you rate your overall job performance in the last month? *

Have you ever missed work due to orthopedic problems that are non-injury-related in the past 6 months? *

Have you ever felt despondent at work? (low, down or hopeless) *

How much time do you spend thinking bout your mental conditions? *

Has it happened that you are at work despite feeling ill? *

How much time do you spend thinking about your finances? *

How often do you complete your daily tasks? *

If you are human, leave this field blank.

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Engagement Assessment

Our Individual Engagement Assessment maps the individual's passions, motivations, expectations and the degree to which their expectations are perceived to be already being fulfilled.

Which option would you prefer having access to? *

Would you refer someone to work where you do? *

How often are you happy at work? *

Do you have a clear understanding of your career promotion path? *

Do you believe your workplace will allow you to reach your full potential? *

How would you rate your work-to-life balance *

Do you believe the leadership team takes your feedback seriously? *

Do you foresee yourself working here one year from now? *

Can you recite your company's values off the top of your head? *

How comfortable do you feel giving negative feedback to your supervisor? *

Do you have fun at work? *

Do you feel like co-workers give each other respect at the office? *

Do you feel your colleagues are competent? *

If you are human, leave this field blank.

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Well-Being Assessment

It means feeling good and functioning well. It can be helpful to maintain an awareness of your overall wellbeing. It can help you to identify the things that have an impact on how well you're doing and give more power in improving your functioning.

When I think about my future, I am happy *

Lately when helping others, I have enjoyed feeling useful. *

I have noticed that I have been feeling relaxed lately. *

I have started taking a liking to meeting people and connecting with them *

I have started dealing with issues a lot better than before *

I have been able to think more clearly these past few days *

My self-esteem has been boosted and I have been feeling good about myself *

I have had a great time getting close to people *

I have been feeling confident *

I have been able to make decisions without the help of others *

I have been feeling more and more loved lately *

I have taken interest in new things *

I have been in a happy and cheerful mood *

If you are human, leave this field blank.

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Sociability Assessment

This assessment will measure your general mental health.

I thrive in isolation, in fact I would be more than happy living on my own in a remote place. *

I love socializing and connecting with others in social settings. *

I love meeting new people and feel lonely when I am not surrounded by others. *

I enjoy participating in voluntary work because I like to be helpful. *

I am still very good friends with the people I have met when I was a child. *

I am often the first to assist with planning and organizing events for work or my family. I enjoy planning events such as birthday parties, competitions, vacations etc *

I try my best to avoid crowded places, where large groups of people usually gather. *

I do not like to socialize very often unles it's with people I know. *

I enjoy going on vacation to places that are either off the grid, remote or far from vacation spots that are usually crowded. *

I am not good at keeping up with friends and family, in fact it takes me a while to respond to messages or requests. *

If you are human, leave this field blank.

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Mental Health Assessment

This assessment will measure your general mental health

In the past two weeks have you been feeling down, depressed or hopeless?

Do you have a support system at home or people who you can talk to?

Do you have a good social life?

When you are sick, is there someone that would look after you?

Do you ever feel depressed for seemingly no reason?

Do you every feel like you are going to burnout?

Do you get angry at small things?

Do you often cry or feel teary?

Do you every feel overwhelmed by life in general?

Do you feel that you would benefit from a 24/7 social worker on call?

If you are human, leave this field blank.

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Health Assessment

Do you suffer from any of the following ? (Multiple options can be selected) *

Allergies

Anxiety

Asthma

Cancer (any type)

Chronic back pain

Depression

Diabetes

Eczema, acne, psoriasis or any skin conditions

Heart disease

High blood pressure

High cholesterol

Joint pain or stiffness

Mental disability

Mental health disorders (not already listed)

Migraines

Physical disability

None of the Above

How often do you exercise in a week? *

How many hours per day do you watch tv ? *

How many hours do you sleep?

Which option would you prefer having access to? *

Do you snore? *

Yes

No

I don't Know

Do you suffer from disrupted sleep ( i.e. Waking in the night or struggling to fall asleep)? *

How often do you suffer from headaches? *

Do you feel you should be wearing glasses? *

Yes

No

I don't know

I wear glasses

How often do you visit a dentist? *

Do you often ask colleagues to repeat what they've said? *

Do you often feel dizzy or faint ? *

Do you often feel fatigued (exhausted and tired )? *

On average how many fruits and vegetables do you consume in a day? *

Do you suffer from constipation or diarrhea? *

Do you eat in secret?

Is healthy eating important to you? *

How often do you eat a healthy breakfast? *

How many times a week do you eat take out ? *

On average, How many drinks of alcohol do you have each week? ( one shot/one glass/ one beer is single drink) *

How often do you visit a doctor?

Do you have a chronic illness? *

If you are human, leave this field blank.

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Nutritional Meal Plan

Would you like a meal plan to assist with diabetes? *

Would you like a meal plan to assist with high cholesterol? *

Would you like a meal plan to assist with heart conditions? *

Would you like a meal plan to assist with weight loss or weight gain? *

If you are human, leave this field blank.

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Nutritional Assessment Breakfast

How many fruits do you add to your breakfssdt? *

Do you have Oats or Cereal for breakfast? *

Do you add dairy products to your breakfast? *

Do you add any other ingredients to your breakfast? *

If you are human, leave this field blank.

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General Health Assessment

Do you suffer from any of the following?

Doyou have any undiagnosed health issues?

Do you snore?

Do you suffer from sleep apnea?

Do you suffer from headaches?

Do you feel that you should be wearing glasses?

Do you go to the dentist regularly?

Do you often find yourself feeling faint and dizzy?

Text

If you are human, leave this field blank.

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Intake Form

Doctor Fill

Name

Surname

Date of Birth

Company Name

Occupation

Marital Status

How often do you exercise

How many cigarettes do you smoke a day?

Do you know your HIV status

Yes

No

Does anyone in your family have the following conditions

Do you have any food allergies?

Yes

No

How often do you drink alcohol every week?

Do you have any medicine allergies

Yes

No

How often do you see a doctor

If you are human, leave this field blank.

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Fitness Assessment - Gym

Have you been to a gym before? *

How long do you want your gym session to be? *

How many times a week do you prefer going to the gym? *

How many times would you like to go to the gym weekly? *

would you like to do more free weights or machines? *

If you are human, leave this field blank.

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No data