Corporate Wellness Screening Form

The Corporate Wellness Screening Form is designed for occupational health clinics, corporate wellness vendors, employer-sponsored health programs, and on-site biometric screening events that need to efficiently collect employee health data as part of workplace wellness initiatives. This employee health screening form captures the demographic and health information required for biometric screenings, health risk assessments (HRAs), and wellness program enrollment, all in a mobile-friendly format that employees can complete on their own device before a screening event or during check-in.

Built for the corporate wellness workflow, this workplace wellness assessment form includes sections for employer and department identification, employee demographics, biometric data entry (height, weight, BMI, blood pressure, resting heart rate, waist circumference), and a comprehensive health risk factor assessment covering tobacco use, alcohol consumption, physical activity level, sleep quality, stress level, and nutritional habits. The medical conditions checklist screens for chronic conditions that are commonly tracked in population health programs -- diabetes, hypertension, high cholesterol, heart disease, asthma, depression, and musculoskeletal conditions -- enabling aggregate reporting that helps employers identify prevalent health risks across their workforce without exposing individual data.

The form includes a wellness program consent agreement that clearly explains how health data will be used, stored, and de-identified for aggregate reporting, addressing HIPAA and GINA (Genetic Information Nondiscrimination Act) requirements that apply to employer-sponsored wellness programs. The emergency contact field ensures safety during on-site screening events. Employers and wellness vendors can customize the biometric fields based on their specific screening protocol, and the structured data output integrates easily with population health dashboards and wellness incentive tracking platforms.