Register for Work Well Live Well Program

Work Well Live Well - Workplace Health Support Service

By completing this form you confirm that your organisation is working towards improving health and wellbeing and would like to receive support and / or information on health and wellbeing at work.

You also consent to your details being added to the Health@Work NI database to receive further information in relation to workplace health and wellbeing. This information will not be shared with third parties.

Contact details:

Organisation name (required)

Organisation address (required)

Organisation postcode (required)

Main contact name (required)

Main contact job title (required)

Telephone number (required)

Email (required)

Tell us about your organisation

Type of organisation (required)

How long has your organisation been in operation? (required)

What percentage of your staff are on the minimum wage? (required)

Give a brief description of what your organisation does: (required)

Employee work patterns (required)

Regular hoursShift patternsBoth

Tell us about your employees

Number of female employees in workforce (required)

Number of male employees in workforce (required)

Number of LGBT&Q employees in workforce (required)

Number of rural employees in workforce (required)

Number of migrant workers in workforce (required)

Number of over 50s in workforce (required)

Number of travellers in workforce (required)

Number of employees with a disability (physical/mental) (required)

How can we help?

Is your headquarters in the Western Trust area ie. Derry/Londonderry, Strabane, Omagh/Fermanagh or Limavady? (required)

Would you be interested in support to carry out an online wellbeing survey and develop a wellbeing plan for staff?

Would you like FREE Workplace Health Champion training for a member(s) of staff? (required)

Would you like to hear more about how you can sign up to the Mental Health Charter? (required)

Would you like to avail of FREE mental health training and support? (required)

How did you hear about the Work Well Live Well program

How did you hear about the Work Well Live Well program? (required)

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