Prepared by

[Your Name]

Date

[Month Day, Year]

Criteria

Rare/Low/None/Isolated

(1 point)

Occasional/Moderate/Basic (2 points)

Regular/High/Constructive/Inspirational (3 points)

Frequent/Proactive/Transformative/Leader (4 points)

Participation Frequency

Participates less than once a month.

Participates 1-2 times a month.

Participates weekly.

Participates multiple times a week.

Initiative Engagement

Engages only in mandatory activities.

Occasionally tries new activities.

Regularly engages in various activities.

Frequently explores new initiatives and encourages others.

Wellness Impact

Shows little to no change in wellness habits.

Demonstrates some positive changes in wellness habits.

Exhibits clear, positive changes in lifestyle and wellness habits.

Achieves substantial improvement in overall wellness.

Peer Influence

Rarely or never influences others to participate.

Occasionallyencourages peers to participate.

Regularly motivates others to join and participate.

Actively leads and organizes activities for peers.

Feedback and Innovation

Does not provide feedback or suggestions

Occasionally provides feedback.

Regularly provides useful feedback and suggestions.

Actively contributes ideas for new initiatives and improvements.