Blue Cross and Blue Shield of North Carolina Wellness Works Award Nomination Form

Blue Cross and Blue Shield of North Carolina (BCBSNC) is committed to improving the health and well-being of its customers and promotes health and wellness across North Carolina. We believe that one of the most effective ways of achieving this is by supporting and encouraging employers’ efforts to create a culture of wellness in the workplace. Through innovative programs, we help organizations across the state improve their employees’ health, contributing to increased productivity and slowing the rise in overall health care costs.

The 2010 Wellness Works Award presented by Blue Cross and Blue Shield of North Carolina recognizes Triangle-area companies that demonstrate the importance of promoting healthy lifestyle choices while fostering an environment that enables employees to take action to improve their health. Blue Cross and Blue Shield of North Carolina applauds all organizations that value preventive programs, screenings, and health education, and encourages applicants to share their most creative ideas for promoting workplace wellness.

CRITERIA
• Privately or publicly held corporation, proprietorship or partnership (not a subsidiary or division).
• Headquartered in Wake, Orange, or Durham counties.
• Member of the Greater Raleigh Chamber of Commerce.
• At least three full years of operation, beginning January 1, 2007.

JUDGING
• A panel of subject matter experts assembled by Blue Cross and Blue Shield of North Carolina will determine the award winner.

DEADLINE
• Application deadline is 5 p.m., Friday, February 27, 2009.

Company Name:

Number of Employees:

Address:

City:

State:

Zip:

Phone:

E-mail:

President/Owner Name :

1. What is your company’s philosophy regarding health and wellness in the workplace?

2. What programs are in place to promote health and wellness in the workplace?
Which is the most well-received?

3. How are Senior Executives involved in health and wellness programming?
Please give specific examples of their involvement.

4. What types of incentives and rewards are given to employees for participating in
worksite health and wellness initiatives?

5. How many (or what percentage of) employees participate in your health and
wellness initiatives?

6. What type of results have you seen from your health and wellness programming?
Please provide specific data or measurements.

7. How has your health and wellness program changed your organization’s environment
as it relates to promoting healthier behaviors?

I certify that, to the best of my knowledge and belief, the information furnished constitutes the true and correct statement of my company’s condition.

President/Owner Name

If submitted by someone other than the president/owner, please complete the information below:
Date

Name

Title

Company

Phone

Fax

E-mail