Sample Health Risk Assessment Page 2
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415. I see my physician for routine check-ups,
25. I regularly take interest in and interact with
health screenings, and disease prevention.
others.
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Safety
Emotional Awareness
16. I wear a seat belt when traveling in a vehicle.
26. My relationships and behaviors are maintained
in a manner which is healthy for me and for
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others.
17. I stay within five miles per hour of the speed limit.
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27. I am able to develop close, personal
relationships with others.
18. I know where to locate and properly use a first aid
kit and fire extinguisher in case of an emergency.
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28. I have positive relationships with both men and
women in my life.
19. I use the recommended safety equipment for all
activities that I participate in (i.e. mouth guards,
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life jackets, hard hats, etc.).
29. I feel that I am a confident individual.
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20. I take the proper precautions to avoid or reduce
workplace accidents. (i.e. clean up spills)
30. I am able to respect others for who they are,
regardless of race, gender, age, attitude, and
interests.
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Social and Environmental Wellness
21. I regularly recycle my paper, plastic, glass and
Mental Wellness
aluminum.
31. I express my feelings of anger and frustration
in ways that are not hurtful to myself or others.
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22. I respect the integrity and property of my
fellow co-workers and the surrounding
32. I set reasonable objectives for myself and strive
environment.
to accomplish them.
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23. I take time to have meaningful interactions
33. I realize when I make mistakes; and I
with family and friends.
understand the consequences that they have on
myself and others.
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24. I contribute time and/or money to at least one
organization that strives to better the
34. I feel that I have family and friends that I can
community where I live.
confide in to assist in managing stress.
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