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Healthy for Life WIP Program <br />2019 Tracking Card <br />f lcLnd-n 4 fiery. <br />DRAFT <br />To participate in the Healthy for Life Wage Incentive Program to receive $XXXX.00 added to your pay in 2020, you must obtain a minimum <br />of 400 points from the list below by XXXXX XX, 2019. To qualify, you must complete Section One, then from Section Two, you must <br />accumulate a total of 400 points. You must complete at least one activity from each "category" in Section Two. If you have questions, <br />please contact HR or call ext. 1023. <br />Section One - Required Activities <br />Tn rvuan6. ..n.. RAI ICT nn _n I.... .1 ..... n...... —L A..:_. <br />Health Risk Assessment - ShareCare - Your Real Agecompletion <br />notification <br />Chapter 5 of Younger Next Year <br />book checked out and written paragraph <br />Annual medical exam - between deadline and 1 yr prior <br />provider certification form <br />Either annual dental or eye exam <br />provider certification form <br />Section Two - Additional Activities You Get to Choose <br />Choose at least one wellness activity from each category Accountability <br />Phvsical Fitness Cateeory <br />10C <br />5C <br />75 <br />75 <br />5C <br />5C <br />5C <br />5C <br />75 <br />5C <br />50 <br />5C <br />Points <br />Fitness- Rec Sports League, Health Club, on your own program, combo, <br />etc - 3 days/wk for at least 2 months <br />submit a calendar <br />100 <br />Try new fitness class/program <br />registration document 0 <br />Wellness Cateeory <br />Food, sugar, or soda tracking for 1 month <br />submit a calendar <br />0 <br />NFP Challenges- at least 1 with every check-in completed <br />NFP's record of participation <br />75 <br />Health Rewards Program - at least 1 event <br />sign in at event, registration <br />50 <br />Try new wellness -related class/program - eating <br />registration document <br />0 <br />Smoking cessasion class/program <br />registration document <br />0 <br />Flu Shot for 2018/2019 flu season <br />city event or form signed by provider <br />50 <br />Education Cateeory <br />Participate in RetireWise - all 4 classes <br />HR will be in attendance at classes 75 <br />Read a book <br />date, what book was about, how reading it 0 <br />helps you have a hearlthier life <br />Try new class/program not related to fitness or wellness <br />registration document 0 <br />Participate in "Healthier Tomorrow" NFP presentation <br />sign in at event 50 <br />Community Service/Social Category <br />i0 Volunteer: Meals on Wheels, donate blood, foodbank, etc... registration or signup 0 <br />i0 Partici ate in a community walk/run/bike copy of registration 0 <br />i0 Attend Employee Appreciation Luncheon jarrival checked -in 50 <br />Total Points (must equal at least 400 to qualify for pay incentive) 4$� <br />Must submit documentation for completion. <br />Name: Date: <br />Congratulationsl You did It! Please submit this Tracking Sheet along with your supporting documentation to Human Resources no later <br />than 4:30 PM on XXXXX X, 20XX or it will NOT be processed and you will forgo the wage incentive for 2020. <br />Wage incentive eligibility per policy. <br />