Safe Routes to School Programs

Governor’s Council Outstanding Healthy Workplace Award

To be considered for this award, an organization must demonstrate its support for healthy lifestyles through its missions, programs or policies. The winning organization should have a well-developed wellness program and opportunities for employees to incorporate health into their daily routine.

Note: For the written portion of this nomination form (located at the bottom), it's recommended that you type your response in a separate word document first and copy/paste your response into the text box area. This will prevent the loss of data should you need more time to fill out this form.

Your Information *First Name: *Last Name: *Address: *City: *State: *Zip:

*Phone Number: *Email: *Relationship to Organization:

Organization Information *Organization Name: *Address: *City: *State: *Zip: *County: *Contact Person: *Contact Person Phone: *Contact Person Email:

*Selection Criteria:

Each response limited to 500 words

Describe the organization’s work that supports healthy lifestyles. Be sure to include specific programs or events that promote physical activity and or nutrition. (5 points)

What strategies does the organization use to track and measure the success of wellness programs? (5 points)
Discuss the organization’s leadership system. How do leaders provide support and encouragement to employees? (5 points)
What policies and benefit options does the organization provide their employees? How do the policies and benefit options support wellness? (5 points)
Describe the organization’s community involvement. What philanthropic events does the organization participate in? (5 points)