Application Form
Employer with Best Employee Health and Wellness Initiatives
Definition: This award seeks to recognize organizations that understand the linkage of employee health to business productivity and have
therefore proactively identified or designed specific health and wellness programs which can support the needs of their employee segments.
Note: This award category will also help determine a list / ranking of the Top 25 participating companies in the Health & Wellness space.
Section A - Participant Information
All questions are mandatory, unless stated otherwise. Your questionnaire may not be considered complete if these questions are left blank.
1. Company Name:_______________________________________________________________________________________
2. SHRM Membership Status:
Member
Non-Member
3. Type of Entity
 Large Companies
 MSME
[Definition of MSME:
For Manufacturing sector: Enterprises which have an investment of not more than ten crore rupees in plant & machinery
For Service Sector: Enterprises which have an investment of not more than five crore rupees in equipment]
4. Nature of ownership in India:
 Corporate
 Partnership / HUF
 Trust



Government body
Foreign owned Multinational corporation
Other (specify) _________________________
5. Date of Incorporation in India (dd-mm-yyyy): ____-____-____
6. Revenues (as of FY 2014-15)
 < INR 50 crore per year
 INR 50-200 crore per year


INR 200-500 crore per year
> INR 500 crore per year
7. Number of Employees (as on 31st March, 2015): ______________
8. Details of SPOC (Single Point of Contact): This could be the CHRO or relevant Functional Head.
 Name: _________________________________

Designation: ____________________________

Contact number : ________________________

Email address : __________________________

Postal address : __________________________
9. HR Metrics:
Metrics
Employee Growth Rate
Gender Ratio
Average Employee Age Group
Value added per employee (e.g. EBIDTA per employee)
Attrition Rate
Offer Drop %
FY 2013
FY2014
FY 2015
No. of Mandatory Trainings (Technical Skills)
No. of Mandatory Trainings (Soft Skills)
Revenue Growth (%)
Profit Growth (%)
Employee Engagement Scores
Customer Satisfaction Scores
Total People Investments (INR) including:
 Total amount spent on employees (Salaries, Benefits, Taxes,
health insurance etc.):
 Total amount spent in support of employees (Real estate,
communications, supplies, IT etc.):
 Total amount spent in lieu of employees (Leasing company
expense, temp workers, costs related to outsourcing etc.,):
 Total amount invested in training & development (learning
cost, travel cost, non-salary development costs etc.):
Management/Leadership Quality
Leadership engagement scoresAn index based on results from a set of relevant questions on an
employee survey. The Leadership Quality index should be based on a
set of survey questions that cover issues such as: Example:
 Vision - do leaders promote a convincing shared vision?
 Alignment - are leaders providing clear direction that link
individual efforts to strategic direction?
 Drive for success - do leaders push to achieve challenging
'stretch' goals?
 Collaboration - do leaders create a collaborative atmosphere
and listen input from employees
 Innovation - are leaders open to new ideas
Section B – Quantitative Measurements
This section covers the quantitative aspects of the initiatives under the concerned category. We strongly recommend providing all the
information that has been asked for under this section as it will enhance your nomination and aid the jury in better evaluation of your
application.
Glossary of key terms used:
FY: Financial Year
FY 2015: First quarter of year 2015
Executives: The top three tiers of your organization i.e. the CEO, Executive Board (or equivalent) and first level reports (does not include Nonexecutive directors). If reporting for a business unit, data should represent the highest parent entity of your organization, not the senior team in
any business unit or country of operation.
Senior managers (Middle management) Level of experience: 8- 15 years
First level managers (Junior Management) Level of experience: 0-8 years
Others: All staff who do not have any people managerial responsibility (i.e. no one reporting to them)
Total number of initiatives across areas:
FY 2013
Health facilities and tools
Club or Gym Memberships
Health Education, Coaching & Counselling
Others (Please specify)
FY 2014
FY 2015
Total number of Wellness programs/workshops conducted:
FY 2013
Stress Management Techniques
Work Life Balance Coaching
Parenting Workshops
Geriatric Care workshops (Elderly care)
Single Parenting Workshops/ Day Care Options
Counselling support to employee’s family
Engaging meaningfully with children
Identifying Anxiety/ Depression and coping with it
Coping with family members with special needs
Creating a healthy work environment/ providing channels
for open communication
Making Lifestyle changes to better quality of life
Music/ Art Initiatives
Encouraging Hobbies/ Exploring Creativity
Yoga/ Meditation
Others (Please specify)
Planned Wellness Initiatives for the coming years
FY 2014
FY 2015
2015-2016
2016-2017
Any other defined
time period
FY 2014
FY 2015
Budget Allocation for these initiatives (In INR)
FY 2013
Funds Allocated across areas
FY 2013
FY 2014
FY 2015
FY 2013
FY 2014
FY 2015
Health facilities and tools
Club or Gym Memberships
Health Education, Coaching & Counselling
Wellness programs/workshops
Others (Please specify)
Number of people impacted through these initiatives
Total number of employees impacted
% of employee strength impacted
Section C - Qualitative Measurements
Qualitative measurements are based on initiatives that have been implemented, or are ongoing in the organization. These would allow for
understanding and evaluating the nature of initiatives, the issues which were addressed by these initiatives, the impact on stakeholders and
efforts to sustain these initiatives.
What were the key issues/challenges or triggers related to instituting these initiatives?
Describe the key initiatives that emerged to address the above-mentioned issues/challenges and their key objectives. Do also mention how
these initiatives reflect in your company's policies?
How did you assess the effectiveness of the initiatives undertaken and what were the results?
[Key pointers – Reduced Absenteeism, Presenteeism change, Better Employee Engagement, Reduced work distress, etc.]
What impact have your initiatives had on your key stakeholders?
[Key pointers – Employee Satisfaction, Better Engagement, Talent attraction & retention, reduced hiring costs, controlled health care losses,
etc.]
What are the key factors that are required for the initiatives to sustain and grow over the next few years?
[Key pointers – Budget allocations, periodic audits, formal defined policy, increasing level of employee involvement etc.]
What was the cost effectiveness of the interventions?
[Key pointers – Cost per employee etc.]
Please use the space below to add any further details/information