SIMPLE Steps to WELLness Challenge
April 15–June 10, 2013
Want to be simply well? Want to earn free stuff while feeling better?
All you have to do is:
1) Submit a personal goal (on page 3), for this two month period and
2) Keep track of your points as you participate in!
Participation points must be tracked and submitted on paper participation log. We have also provided an
easy to use step tracking sheet to help you set goals and track your steps as you use your pedometer!
We encourage you to use an online fitness tracker in conjunction with our paper log. MyFitnessPal is a
great app that you can install on any Smartphone. If you do not have a Smartphone, the tracker can be
used on the computer as well at the following link: http://www.myfitnesspal.com/.
Simple Steps to Wellness Participation Log and Step Tracker can be found at crouse.org/simplywell.
Submit log MONTHLY: Mail or fax each months completed form to:
Sara Kohlbrenner, Employee Health Office, 8 Memorial, or Fax #: 470-1329 according to this schedule:
Month 1 forms due by May 17th
Month 2 forms due by June 14th
Please remember to keep a copy for your records
End of the Year Bonus:
If you turn in every Monthly Participation Log by the due dates (this includes
participation in all three challenges this year), you’ll be entered into a Grand
Prize drawing at the end of the year for a chance to win one of two $250
debit cards.
Incentive Rewards:
Level 1: 100 Points
Reflective Exercise iPod holder Armband with a
hidden pocket to hold keys, money, and ID
Level 2: 200 Points
SimplyWell Insulated Lunch Tote Bag
Spring Challenge Grand Prize:
300 points
Entry into raffle for a chance to win one of four
$50 debit card
End of Year GRAND PRIZE
Entry into raffle to win one of two $250 debit
cards**
**Must participate in all 3 challenges this year to be eligible to be entered into
raffle to win.
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Physical Activity Workout Criteria
The Simple Steps to Wellness incentive program point system accommodates both short and long activity
durations and has a daily point maximum. Employees can accumulate up to six physical activity points
per day PLUS additional points for participating in or attending other activities such as Lunch and learns
and screenings (see extra curricular chart below).
Following the Simply Well participation point system, a range of one to six points will be awarded for
participation in any of the following physical activities: Walking/running, yoga, Pilates, Tai Chi, strength
training, cardiovascular only or cardiovascular and strength training combined, group exercise, team sports
activities, etc.
Physical Activity
Duration
Points
20 minutes
2 points max daily
Other point earning opportunities:
40 minutes
4 points max daily
5,000 - 10,000 per day
4 points max daily
60 minutes
6 points max daily
> 10,000 per day
6 points max daily
Steps
Fruits/Veges
5-9 servings per day
2 points max daily
Water
6-8 8-oz. glasses per day
2 points max daily
Bonus Points
Exercise with a friend
5 points max daily
Use online wellness tracker
5 points max daily
Use pedometer
5 points max daily
The Simple Steps to Wellness Incentive Plan also rewards employees for taking additional “steps” to achieve
overall wellness:
Extracurricular Points Key:
*Biometric Screening(cholesterol, glucose)
*Completing Health Risk Assessment on-line
*Participating with RN Health Coach on phone (if needed)
*Preventative Screening(i.e.Mammo, colonscopy...)
*Annual Exam with your primary care physician
Wellness Education
(Lunch and Learn, Health fair, benefits fair,etc)
Weight Watchers
Nutrition/Diabetes Counseling
Crouse Hospital sponsored Wellness activities
(ie.Making Strides, March of Dimes walk, Adirondack trip, etc.)
Reiki/meditation 30 min. mimimum/day
Meeting your Wellness Goal
*** See Simply Well Personal Goal Statement on following page.
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25 points
25 points
25 points each
15 points each
25 points
10 points each
10 points/session
10 points/session
10 points each
5 points daily max
50 points (Priceless!!)
SIMPLE Steps to WELLness Challenge
Personal Goal Statement
To:
Sara Kohlbrenner, RN, BSN, MPH
Wellness and Population Health Coordinator
Crouse Hospital
[email protected] or Fax to: 470-1329
315-470-8034
I am ready to take the SIMPLE Steps to WELLness Challenge!
Besides tracking activities, I am committed to working toward my own personal goal from April 15,
2013 through June 10, 2013. I understand that my wellness goal will be reviewed by Sara Kohlbrenner, in
your role as Crouse Hospital’s Wellness and Population Health Coordinator, and as a professional
healthcare provider, to determine if it is feasible, realistic and appropriate.
I understand that my personal goal will be kept completely confidential.
My Personal Goal for the challenge time period of April 15, 2013 through June 10, 2013 is:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Print Name: ______________________________
Date: __________________________________
Cell Phone: _____________________________
Email:__________________________________
Please submit personal goal in a sealed envelope addressed to Sara Kohlbrenner, 8 Memorial or
confidential fax to 470-1329.
Goal Examples
Lose % of weight by end of challenge; improve BMI by X-amount; stop smoking,
increase # of steps per day (pedometer tracking); Eliminate drinks with no nutritional value
I.E. soda, diet soda, energy drink…); exercise consistently (i.e. five times per week), Retain
communication with nurse Coach calling with American Health Nurse(if invited to participate);
etc.
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