Become a CommonHealth Worksite Certified Agency…For Your Employees' Health
The CommonHealth Worksite Certified Program recognizes excellence in workplace wellness. CommonHealth Worksite Certified agencies create cultures that are conducive to a healthy workforce through policies and programs, managerial support, and innovative ideas that further the mission of wellness in the Commonwealth.

Benefits of achieving excellence in employee wellness include:
* Increase employee productivity and job satisfaction
* Recruit and retain the best talent
* Reduce lost time
* Boost creativity
* Create a better sense of community at work
* Promote a culture of health for all employees with lifelong benefits

Become a CommonHealth Workplace Certified site and
* Share best practices with other state agencies
* Receive positive recognition for the value placed on employees’ health

Official Name of Agency *
(as you would like it to appear on your certificate, if approved. Ex. Virginia Department of Transportation, Salem Residency)
Your answer
Location *
Your answer
Physical Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Name of Person Completing the Application *
Your answer
Title/Position *
Your answer
Phone Number *
Your answer
E-mail Address *
Your answer
Name of Agency Coordinator
Your answer
Name of Regional Coordinator
Your answer
Your agency must meet these criteria before applying: *
Yes
No
Agency has an identified CommonHealth coordinator
Actively engage employees in two CommonHealth campaigns per year
An overview of the CommonHealth benefit is provided to new employees during orientation
Agency Coordinator attends at least one AC meeting per year
Agency Coordinator distributes weekly wellnotes, Compass newsletters and other CommonHealth materials to employees as requested
Please answer ANY of these questions to support your application. Please include specific examples.
1. How does the management of your organization support employee health and wellness efforts? (Perhaps they encourage participation in CommonHealth programs, support using the 15 minute break for fitness or walking or have policy for all employees supporting breast feeding/pumping opportunities and spaces.)
Your answer
2. What opportunities or policies are in place to encourage employees to move more?
Your answer
3. What opportunities or policies are in place to encourage healthy eating among employees?
Your answer
4. What opportunities or policies are in place to assist employees in managing stress?
Your answer
5. What additional health and wellness opportunities are available to employees at your worksite? (Examples of what is happening at state agencies in various locations; Weight Watchers @ Work, walking club, onsite vegetable garden, onsite weekly produce market.)
Your answer
6. What additional information would you like us to consider in evaluating your application to be a CommonHealth Worksite Certified location?
Your answer
By typing my initials in the following box, I certify that the information above is true and accurate.
Your answer
This completes your form. If approved, you may be re-certified after 5 years.
The application and approval process may take up to 45 days. Your strides in workplace wellness have been noted!
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