The survey should only take a few minutes to complete but please provide accurate and honest answers. Thank you.
Your age (please select)...16 - 2526 - 3031 - 4041 - 5051 - 6061 - 7070 +
Your sex (please select)...MaleFemaleOther
Do you smoke?
Please select...YesNo
How many per day?
Please select...1 - 1011 - 2020+
Would you be interested in accessing free stop smoking services within your workplace (including free NRT/Champix, behavioural support, carbon dioxide monitoring and resources)?
How often do you have a drink containing alcohol?
Please select...NeverMonthly or less2-4 times a month4 or more times a weekDaily
How many units of alcohol do you have on a typical day when you are drinking (one unit = half a pint of larger or one single pub measure of spirit or one small glass of wine)?
Please select...1 or 23 or 45 or 67 to 910 or more
How often do you have six or more drinks on one occasion?
Please select...NeverLess often than monthlyMonthlyWeeklyDaily or almost daily
Do you do any exercise/physical activity?
How much exercise do you do a week?
Please select...1 - 2 times a week3 - 4 times a week5 or more times a week
Do you eat fruit and/or vegetables?
How many portions do you eat a day?
Please select...1 - 23 - 45 - 77+
Do you feel you have someone to talk to if you have a problem or are in a situation that is worrying or concerning you e.g family,friend, Doctor, colleague)?
Have you taken part in a national or local campaign in the last year to improve your health (for example: joined one of the on-site fitness classes, enrolled at a gym, walk to work month, Dry January or Stoptober)?
Would you recommend it to others?
Have you increased your levels of walking in the last year?
How do you travel to work?
Please select...WalkCycleDrivePublic TransportShuttle BusPark and RideOther
Are you aware of opportunities to take part in mindfulness initiatives (For example: mindfulness study days, stress management course, breathing exercise...)?
Have you taken part in any mindfulness opportunities?
Can you see how mindfulness is beneficial to overall well being?
Do you have a long term, stable medical condition that requires regular medicine in the short to medium term?
Do you require regular medicine in respect of that medical condition?
