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Live Well Worksheet

Each quarter you’ll self-report the points you earned using the Live Well Worksheet. You’ll indicate all the activities you participated in, and it will calculate your points for that quarter.


ONLY RECORD POINTS FOR THE STATED TIME PERIOD. DO NOT ADD PREVIOUS ACTIVIES FROM PRIOR QUARTERS.

Indicate which of the Annual point earners you completed this quarter

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

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

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

Indicate which of the events you participated in during the quarter

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


I certify that the above information is accurate and true!

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