Fit-Friendly Mentor Request
Please complete and return to request a Fit-Friendly Worksite Mentor, so the most suitable mentorship match can be made. American Heart Association will make every effort to make your match within 3 weeks of receiving your request. Please contact Cherish Hart at with questions and to submit form.
Contact Information
OrganizationNameAddress, City, Zip
Contact Name/Title
Contact Phone
Contact E-Mail
Organization Description and Goals
Tell us about your organization (industry, etc.), your employees (#, type, locations) and your wellness goals in joining the AHA Fit Friendly Worksite Program (advertise award to attract new employees, increased productivity, reduce health insurance cost, etc.)Wellness Program Status
Where are you on the continuum of wellness program development? Just starting out? Well-developed but would like to continue advancing?Fit Friendly Gold Criteria
Please check the box below if your worksite wellness program includes each activity (to the best of your knowledge):Smoking Policy
☐Smoke free workplace.
Physical Activity
☐Promote walking programs, online newsletters, etc. to motivate employees.
☐Walking meetings with participation from senior management.
☐Stretch breaks or other physical activity during meetings.
☐Clean, safe, stairwells accessible during working hours and promotes use.
☐Indoor walking path, map for walking outside or access to an outdoor facility.
☐12 “Sneakers/Workout Attire” days a year and encourages physical activity on those days.
☐Promotes various physical activity classes (e.g. aerobics, yoga)
☐Free onsite recreation or fitness facilities or discounts at fitness facilities.
☐Reimburses employees for expenses related to fitness tools/programs.
☐Incentives for “physical fitness comp time”, “flexible spending dollars”, or gift certificates to fitness apparel retailers.
☐Other physical activity programs not listed above.
Nutrition
☐Healthy eating information or general nutrition education shared with employees.
☐Cafeteria to offer a minimum of one “healthy” food option and one “healthy” beverage option.
☐Meetings and events to offer one “healthy” food and one “healthy” beverage.
☐On-site vending machines to offer a minimum of 25 percent “healthy” food and beverage options.
☐Discounts on “healthy” food and/or beverages.
☐Other nutrition programs not listed above.
Culture
☐Internal wellness program coordinator available to employees for consultation.
☐Annual employee health risk assessments and feedback.
☐Employee health programs or classes.
☐Procedures to handle employee “at work” health emergencies.
☐Training in CPR, first aid and AED.
☐Other general wellness initiatives not listed elsewhere.