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Pre Assessment RS5K
Pre Assessment Participant Survey
Page
1
of 2
About you
NUID
*
KP National User ID (NUID) for employees
Name
*
First
Middle
Last
Suffix
Email address
*
Facility
*
Please select
Arden Complex
Bell St
Davis Clinic
DOCO
E Roseville Pkwy Offices
Fair Oaks Clinic
Folsom Ambulatory Surgery
Folsom Clinic
Gibson Radiation Oncology
Howe Ave
Lincoln Clinic
Point West Clinic
Professional Drive Clinic
Rancho Cordova Clinic
Roseville Eureka Campus
Roseville Hospital
Roseville Riverside Clinic
Sacramento Hospital
Sierra Gardens Clinic
Sports Medicine
Watt Ave
Department
*
Next
RS5K assessment
Please let us know where you would prefer to participate:
How many days a week do you spend 30 minutes or more walking or doing other forms of moderate to vigorous exercise
outside of work
?
*
Please select
0
1
2
3
4
5
6
7
Days
What are the main barriers that keep you from walking or doing cardiovascular exercise?
*
How often do you feel stressed?
*
1) Never
2) Rarely
3) Sometimes
4) Often
5) Always
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