Healthy Arizona Worksites

Registration

Registering your worksite allows you to access and complete your Healthy Arizona Worksites Assessment. Registration is simple and takes less than 10 minutes.

Please Note! While several people within a worksite can participate in filling in the online assessment, the registration form asks for only one contact. This person will serve as our primary contact person for your worksite's Healthy Arizona Worksites.

 
Primary Contact First Name:
 
Primary Contact Last Name:
 
Job Title:
 
Name of Company:
 
Street Address:
 
City:
 
State:
 
 
Zip Code:
 
 
Phone Number:
 
*Fax Number:
 
 
 
Email Address:
Confirm Email Address:
Company Website URL:
Check this box if no website:
SELECT USERNAME AND PASSWORD
 
 
Username:
Confirm UserName:
 
 
Password:
Confirm Password:

 
Username and password must be at least one character and not more than 12 characters long – numbers and letters only with no special characters (such as apostrophes, hyphens or asterisks) or spaces. The username and this password you select will allow you to log in and access your worksite’s profile and assessment.

ABOUT YOUR WORKSITE

Have you completed/are you completing the assessment for multiple worksite locations?
  


NOTE: If your company has more than one worksite location, you must register and complete assessments for each worksite separately

How many employees are employed at your worksite?
 





 
 
Approximately what percentage of your employees (not including temporary or seasonal) are:
None (0%) 1-25% 26-50% 51-75% 76-100%
Employed full time (full time status is defined by the employer)
Salaried (rather than hourly)
Eligible for employer-paid health benefits
Union members
Manual laborers (work involves physical labor more than 50% of their hours)
Work 2nd or 3rd shift (2nd shift starts between 2 p.m. and 4 p.m.; 3rd shift starts between 10 p.m. and 2 a.m.)
Away from the worksite (sales, delivery, etc) at least 50% of their hours

What type of organization best describes your worksite? If none of the descriptions below are suitable, please choose “other” and provide a brief description of your worksite’s functions.
 
If Other please specify 

Does your worksite have the following:

Stairs in your building
 


Vending machine(s) and/or self-serve snack concessions or snack cart* (no attendant) in which foods are sold
 

 
*A self-serve snack concession or snack cart is similar to a vending machine in that only prepackaged foods and/or beverages are sold and there is no attendant to prepare or serve food.

Vending machine(s) and/or self-serve snack concessions or snack cart* (no attendant) in which beverages are sold
 


*A self-serve snack concession or snack cart is similar to a vending machine in that only prepackaged foods and/or beverages are sold and there is no attendant to prepare or serve food.

A cafeteria or snack bar (with attendant)* for employees
 


*To qualify as a cafeteria or snack bar with attendant, food (and sometimes beverages) is served by cafeteria or snack bar personnel and offerings include more than prepackaged foods. Break rooms where employees may gather to eat lunches brought from home or purchased, or vending machine rooms with tables do not qualify as cafeterias.


NOTE ABOUT YOUR PRIVACY: Your contact information (email address, name, phone number) will not be shared with anyone except Arizona Department of Health Services (ADHS) staff administering the assessment and this website without your written permission or except as otherwise provided by law. The ADHS team may use this information to provide you with updates and reminders related to the site. For more on how we protect your privacy, visit the Privacy page of this website.