LIve Well Chelan

Your Name

Your Email

Time Period

Annual Point Earners

Indicate which of the Annual point earners you completed this quarter

Complete the Castlight Heath Assessment

Get an Annual Physical

Get a Flu Shot

Get a hearing test

Get a Preventative Dental Visit (2x/year)

Max Out Your City Match to Retirement Benefit

Get an Annual Eye Exam

Month #1 Point Earners

Indicate which of the monthly point earners you completed the first month of the quarter

Submit your Wellness Reimbursement

12 Hours on your Wellness Workout Challenge

Check Out a Wellness Item for Hour of Use

Spend 1 Hour Volunteering in your Community

Spend 2 Hours Volunteering in your Community

Spend 3 Hour Volunteering in your Community

Complete 1 Hour of Professional Development

Complete 2 Hours of Professional Development

Complete 3 Hours of Professional Development

Weekly Puzzlers

Month #2 Point Earners

Indicate which of the monthly point earners you completed the second month of the quarter

Submit your Wellness Reimbursement

12 Hours on your Wellness Workout Challenge

Check Out a Wellness Item for Hour of Use

Spend 1 Hour Volunteering in your Community

Spend 2 Hours Volunteering in your Community

Spend 3 Hour Volunteering in your Community

Complete 1 Hour of Professional Development

Complete 2 Hours of Professional Development

Complete 3 Hours of Professional Development

Weekly Puzzlers

Month #3 Point Earners

Indicate which of the monthly point earners you completed the third month of the quarter

Submit your Wellness Reimbursement

12 Hours on your Wellness Workout Challenge

Check Out a Wellness Item for Hour of Use

Spend 1 Hour Volunteering in your Community

Spend 2 Hours Volunteering in your Community

Spend 3 Hour Volunteering in your Community

Complete 1 Hour of Professional Development

Complete 2 Hours of Professional Development

Complete 3 Hours of Professional Development

Weekly Puzzlers

Event Participation

Indicate which of the events you participated in during the quarter

January: Employee Engagement Survey

February: 2025 Goal Setting Worksheet

March: Time Management Workshop

April: Healthy Cooking

May: Spring Hike

June: Summer Kick-off BBQ

July: Hydration Challenge

August: Gratitude at Work Workshop

September: Food Drive (Humans & Pets)

October: Benefits Fair

October CPR Class

November: Souper Wednesday Soup-Eater

November: Souper Wednesday Soup-Maker

December: Blanket & Coat Drive

Did you complete 12 hours each month for the Wellness Workout Challenge?

3 months of activity qualifies you for a $50 Amazon Gift Card. This will be sent to your city email address. PLEASE NOTE: Gift cards to staff are considered taxable income, and may be added to payroll records and impact tax withholdings.

	12 Hours of Activity Completed
Month 1
Month 2
Month 3

TOTAL POINTS CLAIMED

You have claimed ${POINTS()} Live Well Points for this quarter

Your Signature

I certify that the above information is accurate and true!

Total score

Live Well Worksheet

TOTAL POINTS CLAIMED

Live Well Worksheet