Showcase Application

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Canada's Healthy Workplace Month

Showcase Application Form

Canada’s Healthy Workplace Month^® (CHWM) celebrates and showcases outstanding initiatives being taken by small, medium and large organizations across Canada. Whether your workplace is not-for-profit, public, private sector, small or large, we want to hear how you’re supporting employee well-being and organizational health.

Showcase your efforts to the Healthy Workplace Month community. Apply now for our showcase by completing the form below.

TIPS FOR COMPLETING YOUR APPLICATION

Keep your answers concise and to the point.
Click the “Save Application” button at the bottom of this form to save your progress. To resume your application, use the assigned link to continue.
When finished, click on the “Submit” button at the bottom of this form. (Note: All required fields need to be completed in order to submit.)

Please note that your information is saved on our server as you enter it. Please note file uploads will not be saved.

CONTACT INFORMATION
Name*
First Last
Phone*
Email*
How did you hear about Canada's Healthy Workplace Month?
- Please send me news and updates regarding Canada's Healthy Workplace Month.
ABOUT YOUR ORGANIZATION
Organization Name*
Website
Number of full-time employees
Number of part-time employees
Please provide URLs for any social media sites managed by your organization such as Facebook, LinkedIn, Twitter, etc.
About Your Initiative
Name of your initiative
Number of employees targeted in organization
Number of Participants in initiative
Untitled*
Goal(s) of the initiative (S.M.A.R.T.)
Untitled*
What need was addressed with this initiative?
Untitled*
What were your results?
Untitled*
How was the initiative implemented? (If someone wanted to replicate your initiative, how would they do it?)
Untitled*
How did you evaluate your initiative?
What was the approximate cost per participant?
Supporting Documentation (if applicable)
Drop files here or

Max. file size: 100 MB.
Upload Supporting Material
Please attach any photographs, posters and/or promotions associated with your initiative for posting on the CHWM website. Note that we will identify your organization but we will not identify the contact person or his/her contact information. If documents contain personal contact information, we will conceal it.
File
Drop files here or

Max. file size: 100 MB.
Representative Authorization
*
- By checking this box, I agree on behalf of my organization to allow my company initiative (with the exception of my name, telephone number and email address) to be showcased on the CHWM website. I understand that my organization's name may be used in promotional materials and on the CHWM website. I agree to allow CHWM to share my responses to the above questions (with the exception of my name, telephone number and email address) with other organizations and the public.
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Canada's Healthy Workplace Month

CONTACT INFORMATION

ABOUT YOUR ORGANIZATION

About Your Initiative

Upload Supporting Material

Representative Authorization

CHWM

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