Mind Your Health
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Hi There Want to be your best you? Then take this quick 10 minute "Mind Your Health" check to get you started. Remember this survey is entirely voluntary. The information you provide will remain anonymous and be kept strictly confidential by CBI. Most importantly, the information provided will not be in any way identifiable to you. Please note that by completing this survey, you give consent for the anonymous data to be provided by CBI to Coles to assist in tracking the health status of Coles Team Members. If you require more information regarding the consent process or require a copy of CBI’s Privacy Policy, please contact CBI on 1300 21 31 41
- 1.Do you speak English at home?
- A.
Yes
- B.
No
- 2.What is your age?
- A.
Under 35 years
- B.
35-44 years
- C.
45-54 years
- D.
55-64 years
- E.
65 years and over
- 3.What is your gender?
- A.
Male
- B.
Female
- 4.Are you of Aboriginal, Torres Strait Islander, Pacific Islander or Maori descent?
- A.
Yes
- B.
No
- 5.Where were you born?
- A.
Asia, Middle East, North Africa, Southern Europe
- B.
Other (including Australia, NZ, North America, Western Europe)
- 6.Have either parent or any brothers or sisters been diagnosed with diabetes (type 1 or 2)?
- A.
Yes
- B.
No
- 7.
- A.
Yes
- B.
No
- 8.Are you currently taking medication for high blood pressure?
- A.
Yes
- B.
No
- 9.Do you currently smoke cigarettes or any other tobacco products on a daily basis? Please be aware that any level of smoking is putting your health at risk. We encourage you to consult your GP for information and support if you are considering quitting smoking. We have also included information on mycoles to guide you.
- A.
No
- B.
Yes
- 10.How often do you eat vegetables or fruit?
- A.
Every day
- B.
Not every day
- 11.On average, would you say you do at least 2.5 hours of physical activity per week?E.g. 30 minutes a day on 5 or more days per week
- A.
Yes
- B.
No
- 12.What is your waist measurement?Note: The last 3 options are for people with Asian, Aboriginal or Torres Strait Islander descent.The first 3 options are for people with all other backgrounds.No tape measure? Women's clothing and waist sizeClothing size1012141618202224Waist (cm)81879399105111117123Men's clothing and waist sizeClothing sizeSMLXLXXLXXXLWaist (cm)9199107115123131Sourced from Diabetes Australia VicPlease be aware that regardless of the risk category you fall into at the end of this questionnaire, increased waist circumference is a risk factor for heart disease, diabetes, stroke and some cancers. If you select the 2nd, 3rd, 5th or 6th option, your waist circumference is above the healthy recommendations.
- A.
Less than 102cm (for men) or less than 88cm (for women) - NOT Asian, Aboriginal or Torres Strait Islander descent
- B.
102-110cm (for men) or 88-100cm (for women) - NOT Asian, Aboriginal or Torres Strait Islander descent
- C.
More than 110cm (for men) or more than 100cm (for women) - NOT Asian, Aboriginal or Torres Strait Islander descent
- D.
Less than 90cm (for men) or less than 80cm (for women) - ONLY FOR Asian, Aboriginal or Torres Strait Islander descent
- E.
90-100cm (for men) or 80-90cm (for women) - ONLY FOR Asian, Aboriginal or Torres Strait Islander descent
- F.
More than 100cm (for men) or more than 90cm (for women) - ONLY FOR Asian, Aboriginal or Torres Strait Islander descent
- 13.On an average day, how many servings of vegetables or legumes do you eat each day?Examples of 1 serving:
- 1/2 medium potato
- 1/2 cup cooked vegetables - e.g. carrot, broccoli, spinach, sweet corn or pumpkin
- 1 cup leafy green or salad vegetables
- 1 medium tomato
- 1/2 cup cooked lentils or beans
- A.
0-1
- B.
2-4
- C.
5+
- 14.On an average day, how many serves of fruit do you eat each day?Examples of 1 serve :
- 1 medium piece (e.g. apple or banana)
- 2 small pieces (e.g. kiwifruit or apricots)
- 1 cup chopped fruit
- A.
0
- B.
1
- C.
2
- D.
More than 2
- 15.How often during your working week do you eat breakfast?
- A.
Never
- B.
1-2 days
- C.
3-4 days
- D.
5 days or more
- 16.How often do you drink sugary drinks? Include all energy drinks, soft drinks, fruit juice or cordial
- A.
Never
- B.
Once a week or less
- C.
Several days a week
- D.
Most days
- 17.How many serves of treat foods do you have a day?Example of 1 serve =
- 2 scoops (75g) ice-cream
- ½ snack-size packet (30g) salty crackers or crisps
- 2-3 (35g) sweet plain biscuits
- 1 (40g) doughnut
- 1 slice (40g) plain cake/small cake-type muffin
- 5-6 (40g) sugar confectionary/small lollies
- 1 tblsp (60g) jam or honey
- ½ bar (25g) chocolate
- 1 can (375ml) soft drink (sugar-sweetened)
- ¼ pie or pastie (60g) commercial meat pie or pastie (individual size)
- 12 (60g) fried hot chips
- 200ml wine (2 standard drinks; but note this is often 1 glass for many Australian wines)
- 60ml spirits (2 standard drinks)
- 600ml light beer (1½ standard drinks)
- 400ml standard beer (1½ standard drinks)
- A.
0-2 serves
- B.
3-4 serves
- C.
More than 4 serves
- 18.Do you participate in regular exercise/activity outside of work?
- A.
Yes
- B.
No
- 19.How many hours a week do you do aerobic movement? E.g. brisk walking, jogging, cycling or swimming.
- A.
Less than 1.5 hrs
- B.
1.5 to 2.5 hours
- C.
More than 2.5 hours
- 20.How many hours a week do you perform resistance movement?E.g. push ups, sit ups, free weights, machine weights or Pilates
- A.
Less than 1 hour
- B.
1-2 hours
- C.
More than 2 hours
- 21.How often do you drink alcohol?
- A.
5 or more times a week
- B.
2-4 times a week
- C.
Once per week
- D.
Never
- 22.If you drink, how many times per week would you drink more than 2 standard drinks?Standard drink = 285ml full strength beer, 100ml wine or 30ml spirits
- A.
0
- B.
1-3
- C.
4-5
- D.
More than 5
- 23.How often do you have more than 4 standard drinks a day?Standard drink = 285ml full strength beer, 100ml wine or 30ml spirits
- A.
Daily
- B.
A few times a week
- C.
Weekly
- D.
Monthly or less
- E.
Never
- 24.How many hours do you typically work in a 7-day week?
- A.
Full time hours (approx. 40 hours per week)
- B.
Full time hours plus weekly additional hours beyond your paid hours
- C.
Part time hours
- D.
Part time hours plus weekly additional hours beyond your paid hours
- 25.Are you happy with the balance between your work life and your personal life?
- A.
All of the time
- B.
Most of the time
- C.
Some of the time
- D.
None of the time
- 26.How would you describe your social networks?
- A.
Poor
- B.
Fair
- C.
Good
- D.
Excellent
- 27.Do you enjoy work?
- A.
All of the time
- B.
Most of the time
- C.
Some of the time
- D.
None of the time
- 28.Do you feel a part of the team within your workplace?
- A.
Never
- B.
Occasionally
- C.
Mostly
- D.
Always
- 29.Do you feel that people respect you as a person (at work and outside of work)?
- A.
All of the time
- B.
Most of the time
- C.
Some of the time
- D.
None of the time
- 30.Do you find it easy to relax when you get home from work?
- A.
All of the time
- B.
Most of the time
- C.
Some of the time
- D.
None of the time
- 31.Do you feel you have purpose in your life?
- A.
All of the time
- B.
Most of the time
- C.
Some of the time
- D.
None of the time
- 32.Are you optimistic about your future and feel you have a sense of control in your life?
- A.
All of the time
- B.
Most of the time
- C.
Some of the time
- D.
None of the time
- 33.How many hours per night would you typically sleep?
- A.
Less than 6
- B.
6-7
- C.
7-8
- D.
More than 8
- 34.How would you describe your current stress levels?
- A.
Well controlled all the time
- B.
Stressed some of the time
- C.
Stressed a lot of the time
- D.
Stress is having a negative impact on my life
- 35.How would you describe your fatigue levels at work?
- A.
I generally don't feel fatigued at work
- B.
I sometimes feel fatigued at work
- C.
I feel fatigued at work most of the time
- D.
I always feel fatigued at work
- 36.Are you currently taking medication for a health condition?
- A.
Yes
- B.
No
- 37.Have you ever experienced or are currently experiencing depression and/or anxiety?
- A.
Yes I am currently experiencing one of these conditions
- B.
Yes I have experienced one of these conditions in the past
- C.
No I have never experienced one of these conditions
- 38.How would you describe the level of support and resources available to manage wellbeing issues in the workplace?
- A.
Poor
- B.
Fair
- C.
Good
- D.
Excellent
- 39.If you have an issue about your wellbeing, do you feel comfortable to raise this with your direct manager?
- A.
Yes
- B.
No but I have others at work I can confide in
- C.
No I do not feel I have anyone at work I can confide in
- 40.What other programs or activities would you like to see put in place to create an environment where people feel as comfortable talking about their mental health as they do their physical health ?
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