Staff Health & Wellbeing Champions - Programme Evaluation Year 2 - Page 1 of 4 - NI Direct

Demographics

1. Name

Name (Required)

2. Job Title

(Required)

3. Department

(Required)

4. Division/Directorate

(Required)

5. Are you a Registered Nurse / Work within a nursing role?

(Required) Yes No

6. Date of Staff H&W Programme

Day (dd)
-

Month (mm)
-

Year (yyyy)