Quench Your Thirst Challenge Log

Form Approved

OMB No. 0920-XXXX

Expires XX-XX-XXXX

Wellness Challenge Logs

Public reporting of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

Respondents/Sources	Method	Content	Timing/Frequency	Respondents	Time
Employees participating in Wellness Challenges -- all worksites	Paper and pencil log book	Self-monitoring tools for health behaviors (nutrition, physical activity)	Throughout the implementation period; max. 3 times per year	2,285	@ 0.50 hrs

Implementation: The wellness change logs are completed by wellness challenge participants via paper and pencil to monitor their lifestyle habits and progress toward wellness challenge goals throughout the challenge / campaign period. These logs will be made available to employees if the challenges are included in the participating employer’s health improvement plan.

Introduction

These wellness challenge logs are tools that you may voluntarily chose to use. They ask about your healthy habits in specific program areas: water consumption, physical activity, fruit and vegetable consumption, fiber consumption, weight gain / maintenance as part of an individual or company-wide wellness challenge. If you choose to use them, these logs should take about 30 minutes each to complete over an 8-week period. These challenge logs are used as part of the National Healthy Worksite Program funded by the Centers for Disease Control and Prevention and is being conducted by Viridian Health Management (Viridian). Viridian is an independent company headquartered in Phoenix, AZ.

Informed Consent

Before you get started, we’d like need to give you some more information to help you decide whether or not you would like to participate.

• This project is funded by the Centers for Disease Control and Prevention. Many parts of the project are being managed by Viridian Health Management (Viridian). Viridian is a private health and wellness company based in Phoenix, AZ. Viridian provides flexible, customized solutions to building comprehensive healthy worksite programs. They are helping CDC implement the National Healthy Worksite (NHW) program.

• You were offered the opportunity to voluntarily choose to use these logs to help you track your health habits.

• Your participation in completing these logs is voluntary. In the course of completing the logs, you may refuse to answer specific questions. You may also choose to end your participation at any time.

• Completing the logs is designed to take about 30 minutes.

• There are no right or wrong answers or ideas.

• All of the comments you provide will be maintained in a secure manner. We will not disclose your responses or anything about you unless we are compelled by law. Your responses will be combined with other information we receive and reported in the aggregate as feedback from the group. In our project reports, your name will not be linked to the comments you provide in this discussion.

• CDC is authorized to collect information for this project under the Public Health Services Act.

• There are no personal risks or personal benefits to you for participating in this discussion.

• We are interested in your comments so that we can improve the NHW program for future participants. Please feel free to contact [INSERT WORKSITE NHWP PROGRAM MANAGER]. [HIS/HER] number is [INSERT TEL #]. You can also call Viridian Health Management toll-free at 1-877-486-0140.

Instructions

To make sure that health-related information and programs are tailored to affect your health problems and concerns, we are asking each employee participating in health coaching to consider using these logs.

Please bring the log with you to your health coaching sessions. Once completed, you can give it to [INSERT WORKSITE NHWP HEALTH COACH] if you chose to. If you have any questions, Please feel free to contact [INSERT WORKSITE NHWP HEALTH COACH]. [HIS/HER] number is [INSERT TEL #].

Thank you very much for your participation.

Specific instructions for the wellness challenges are below.

Wellness Challenge Overview

Participant Goals:

• Lose 1 lb. per week for 8 weeks.

• Learn tips to become more physically active.

• Understand proper portion sizes.

• Learn simple ways to reduce daily calorie intake.

Challenge Materials/Support:

Required: log book & handouts

Participant Instructions:

• Obtain a log book from you onsite health coach.

• Learn how to balance your calories consumed and energy expended.

• Track your daily food intake and exercise for eight weeks.

• Weigh yourself and enter your weight each week for 8 weeks in your log book.

Participant Goals:

• Eat a minimum of 5 servings of fruits and vegetables each day for 4 weeks.

• Learn tips to eat more fruits and vegetables.

• Learn the health benefits of eating more fruits and vegetables.

Challenge Support / Materials:

Required: log book & handouts

Optional: Veggie /Fruit Carving board, vegetable peeler, t-shirts (require employer / budget approval)

Participant Instructions:

• Obtain a log book from you onsite health coach.

• Learn the benefits of eating at least 5 servings of fruits and vegetables.

• Track your daily servings of fruits and vegetables for 4 weeks in your logbook.

Participant Goals:

• Eat at least 21 grams of fiber per day for 4 weeks.

• Learn the health benefits of eating fiber.

• Identify foods that have high fiber content .

Challenge Support / Materials:

Required: log book & handouts

Participant Instructions:

• Obtain a log book from you onsite health coach.

• Learn the benefits on consuming adequate amounts of fiber and what foods are high in fiber.

• Track your daily grams of fiber each day for 4 weeks in your log book.

Participant Goals:

• Increase physical activity over by 10% per week for 4 weeks.

• Learn the health benefits of walking and physical activity.

• Learn ways to walk more every day.

Challenge Materials:

Required: log book, handouts &pedometers

Participant Instructions:

• Obtain a log book from you onsite health coach.

• Learn the benefits of walking and daily physical activity.

• Track your baseline steps by wearing a pedometer and calculating your average daily steps. (week 1).

• Wear your pedometer every day for 4 weeks and log your steps in your log book.

Participant Goals:

• Drink at least 64 oz. of water each day for 4 weeks.

• Learn the health benefits of drinking water.

• Learn easy ways to drink more water and make health drink choices.

Challenge Materials:

• Required: log book & handouts

• Optional: water bottles, cooling neck wraps

Participant Instructions:

• Obtain a log book from you onsite health coach.

• Learn the benefits of drinking water and reducing the amount of sugared beverages.

• Track your daily ounces of water every day for 4 weeks in your log book.

Participant Goals:

• Get a minimum of 7 hours of sleep each night and eat a healthy breakfast each day for 4 weeks.

• Learn techniques to get a good night sleep.

• Learn the health benefits of eating a healthy breakfast.

Challenge Support / Materials:

Required: log book & handouts

Optional: Small giveaway bag (small bag with tea bags, stress lotion, etc) (Requires employer / budget approval).

Participant Instructions:

• Obtain a log book from you onsite health coach.

• Learn the benefits on consuming adequate amounts of fiber and what foods are high in fiber.

• Track the hours of sleep you get each night and record whether you ate a healthy breakfast each day in your log book.

Participant Goals:

• Maintain your weight for 12 weeks from October to January 1.

• Learn tips for health holiday meals.

• Learn how to incorporate physical activity during the hectic holiday season.

Challenge Materials:

Required: log book & handouts

Participant Instructions:

• Obtain a log book from you onsite health coach.

• Learn the benefits of being active, eating nutritiously, and reducing stress over the holidays to maintain your weight.

• Weigh yourself and record your weight in your log book at the beginning of the challenge.

• Review the Maintain don’t Gain materials each month.

• Weigh yourself each month for 3 months and record your weight in your logbook.

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