Employee Wellness Contract

Employee Wellness Contract

Parties and Recitals

This Employee Wellness Contract (the "Contract") is made between Employer Name: and Employee Name: . The parties agree that the Employee will participate in the Employer's wellness program on the terms set forth below.

Personal Information

Position Information

Wellness Program Description and Participation

Program Name: . Program Start Date: . Program End Date: .

The Employee elects to participate in the following components (select all that apply):

Biometric screening (blood pressure, cholesterol, glucose)

Fitness reimbursement / membership subsidy

Health coaching / counseling

Smoking cessation program

Nutrition education program

Wellness Goals and Personal Plan

Incentives, Funding, and Reimbursement

Incentive Description: . Maximum Incentive Amount: $.

Reimbursement Procedure: Employee must submit receipts and authorized forms within days of expense. Employer will process reimbursements in the next payroll cycle following approval.

Health Information, Confidentiality, and Data Use

The Employee acknowledges that certain program activities may collect health-related information. Employer agrees that individually identifiable health information will be treated as confidential and only used or disclosed for administration of the wellness program, for aggregate analysis, or as required by law. Employee consents to disclosure of de-identified or aggregated information for program evaluation.

Consent to share limited health data with third-party wellness vendors and authorized claims processors: I consent.

Assumption of Risk and Release

The Employee acknowledges participation in program activities is voluntary. The Employee agrees to follow program rules and acknowledges that Employer is not liable for injuries arising from voluntary fitness activities or participation in wellness events, except where such liability cannot be disclaimed by law. Employee releases Employer from any claims related to participation except for willful misconduct or gross negligence.

Program Rules, Termination and Modification

Employer reserves the right to modify, suspend or terminate the wellness program, eligibility criteria, or incentives at its discretion with written notice to employees. Participation in the program is a condition of receiving program-specific incentives but does not alter the at-will nature of employment unless expressly agreed in a separate, signed employment contract.

Employment History (Provide most recent employers)

Education

References (Professional)

Legal Disclosures

At-Will Employment: Participation in the wellness program does not change the at-will nature of employment. Either the Employee or Employer may terminate the employment relationship at any time, with or without cause or notice, unless otherwise agreed in a separate written agreement signed by both parties.

Equal Opportunity: Employer maintains a policy of equal employment opportunity and will not discriminate in program participation or incentives on the basis of protected characteristics. Program eligibility, incentives, and administration will be applied in a nondiscriminatory manner consistent with applicable law.

Authorization and Acknowledgments

Applicant Certification: I certify that all information provided in this Contract and accompanying materials is true and complete to the best of my knowledge. I understand that false statements may result in denial of incentives or disciplinary action.

Authorization to Contact Previous Employers and Conduct Background Checks: I authorize Employer and its agents to contact my prior employers and to conduct background checks or verifications as necessary to administer program eligibility and incentives.

Medical Clearance: If program activities require physical exertion beyond ordinary daily activities, Employee affirms they have consulted with a medical professional or will do so prior to participation if recommended. Employee agrees to immediately disclose any medical conditions that could affect safe participation.

Indemnification and Remedies

Employee agrees to indemnify and hold Employer harmless from claims arising out of Employee's negligent or intentional misconduct in connection with program participation, except to the extent Employer's own negligence is the proximate cause of injury.

Any dispute arising from this Contract shall first be raised in writing and the parties will attempt to resolve through direct discussion. If unresolved, disputes shall be resolved under the governing law specified below.

Notices

Notices required by this Contract must be in writing and delivered to the addresses set forth in the parties' records. For purposes of this Contract, electronic notice to the Employee's email on file constitutes effective notice.

Acknowledgment of Receipt

By signing below, the Employee acknowledges receipt of the wellness program terms, agrees to abide by program rules, and consents to the uses and disclosures of health-related information as described herein.

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