Register – Life EHS Employee Health Solutions

Registration

Tell us more about yourself so that we can deliver articles that are specific to your health, wellness and financial needs. The information requested below is for verification purposes and to offer you a personalised content experience. All supplied information will remain strictly confidential.

1 Personal Details

2 Work Details

3 Health & Wellness

4 Stress & Mental Wellbeing

5 Fatigue

6 General Interests

Name*
Surname*
Organisation / Company Name*
E-mail*
Date of Birth*
Date Format: YYYY slash MM slash DD
Phone Number
ID / Passport Number*
Gender*
Which of the following best describes your marital status?*
Do you have children under the age of 18?*
- Yes
- No
What are the ages of each of your children?
In which country do you reside?*
In which province do you reside?*

Which of the following best describes your current job?*
Which of the following best describes the sector in which you work?*
What is the level of activity at your job?*
How many working days have you been off sick in the last 12 months?*
How do you rate your productivity? (out of 100%)*
How long do you spend at a desk/in front of a computer every day?*

Do you eat on the run, grabbing anything when you feel too hungry?*
Do you feel rundown, stressed out, burnt-out, exhausted or do you suffer from frequent colds, cold sores or other infections?*
Are you tired, down in the dumps or don't you have enough time to exercise regularly?*
Do you struggle to fall or stay asleep at night?*
Do you feel angry, worried, afraid or anxious?*
Do you feel that your life is out of control?*
Do you eat, drink alcohol or smoke when you feel nervous?*
Do you become aggressive, angry or upset when things aren't going the way you planned, when people don't react the way you want them to or when you cannot control the situation?*

Do you fall asleep when you are sitting and reading?*
Do you fall asleep when you try to watch TV?*
Do you fall asleep in meetings?*
Do you fall asleep when you are in a car with someone?*
Do you like to sleep in the afternoons?*
Do you fall asleep while you are talking to people?*
Do you fall asleep after lunch, even if you didn’t have any alcohol?*

Registration

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