EMPLOYEE WELLNESS PROGRAM COMPLIANCE CHECKLIST (HR)

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--- PROGRAM DESIGN & ELIGIBILITY ---
[ ] Program Eligibility Criteria (All Employees, Specific Departments, Based on Tenure, Based on Health Risk Assessment Results)
[ ] Minimum Employee Participation Rate (%),
[ ] Program Start Date
[ ] Incentive Types Offered (Gift Cards, Premium Discounts, Merchandise, Cash Rewards)
[ ] Detailed Explanation of Eligibility Requirements
[ ] Method for Determining Eligibility (Self-Attestation, Manager Verification, HR Verification)

--- PRIVACY & DATA SECURITY ---
[ ] HIPAA Compliance Assessment (Compliant, Partially Compliant, Not Compliant)
[ ] Data Encryption Methods Used
[ ] Employee Consent Form Obtained? (Yes, No)
[ ] Last Privacy Policy Review Date
[ ] Number of Data Breaches Reported (Past Year)
[ ] Description of Data Access Controls
[ ] Third-Party Vendor Security Agreements in Place? (Yes, No)

--- COMPLIANCE WITH ADA & FMLA ---
[ ] Does the wellness program offer accommodations for individuals with disabilities? (Yes, No, Not Applicable)
[ ] Describe the process for requesting and approving reasonable accommodations for program participation.
[ ] Are employees informed about their right to FMLA leave related to wellness program participation? (Yes, No, Not Applicable)
[ ] Outline how FMLA leave requests related to wellness program participation are handled.
[ ] Number of FMLA requests related to wellness program participation in the last year.
[ ] Date of last review of ADA/FMLA compliance related to wellness program.

--- NON-DISCRIMINATION & EQUAL ACCESS ---
[ ] Program Access Barriers Identified? (Yes, No, Not Assessed)
[ ] Describe any identified barriers to equal access (e.g., language, disability, geographic location).
[ ] Which groups are specifically targeted for outreach to ensure equitable participation? (Employees with Disabilities, Employees from Diverse Ethnic Backgrounds, Employees with Limited English Proficiency, Employees in Rural Locations, Other (Specify))
[ ] Describe outreach strategies implemented to reach targeted groups.
[ ] Are program materials available in multiple languages? (Yes, No, N/A)
[ ] Accommodations offered for employees with disabilities? (Yes, No, Policy Exists, Rarely Utilized)

--- VENDOR MANAGEMENT & CONTRACTS ---
[ ] Vendor Due Diligence Completed? (Yes, No)
[ ] Contract Start Date
[ ] Contract Expiration Date
[ ] Summary of Key Contract Terms
[ ] Copy of Vendor Contract
[ ] Contract Reviewed by Legal? (Yes, No)
[ ] Vendor Insurance Coverage Amount
[ ] Notes on Vendor Performance/Concerns

--- PARTICIPATION & COMMUNICATION ---
[ ] Summary of Program Communication Plan
[ ] Date of Last Communication Distribution
[ ] Communication Channels Used (Email, Intranet, Posters, Team Meetings, Company Newsletter)
[ ] Estimated Employee Reach (%) of Communications
[ ] Sample Communication Materials (e.g., flyer, email)
[ ] Method for Ensuring Employee Awareness (e.g., Acknowledgement Form) (No formal acknowledgement, Employee Acknowledgement Form, Training Session Attendance)
[ ] Description of Employee Onboarding Wellness Information

--- TAXATION & REPORTING ---
[ ] Total Value of Wellness Incentives Provided
[ ] Date of IRS Form 679 Reporting (if applicable)
[ ] Wellness Program Structure (e.g., Incentives, Discount) (Incentives, Discounts, Other)
[ ] Number of Employees Receiving Incentives
[ ] Summary of Tax Implications Considered
[ ] Method Used to Determine Taxable Value of Incentives (Safe Harbor Method, Retrospective Method, Other)
[ ] Date of Last Tax Consultation (Optional)

--- DOCUMENTATION & RECORDKEEPING ---
[ ] Date of Record Creation
[ ] Summary of Wellness Program Documentation Review
[ ] Copy of Employee Consent Forms (if applicable)
[ ] Number of Participating Employees (Active)
[ ] Records of Vendor Audits/Assessments
[ ] Date of Last Program Documentation Update
[ ] Notes on Data Security Protocols

--- PROGRAM EVALUATION & UPDATES ---
[ ] Last Program Evaluation Date
[ ] Employee Participation Rate (%)
[ ] Employee Satisfaction Score (Scale of 1-5)
[ ] Summary of Employee Feedback (Qualitative Data)
[ ] Were Program Goals Met? (Yes, No, Partially)
[ ] Recommendations for Program Improvement
[ ] Date of Next Program Review

--- INCENTIVE STRUCTURE COMPLIANCE ---
[ ] Maximum Incentive Value (USD)
[ ] Incentive Type (Cash, Gift Card, Premium Reduction, Other)
[ ] Percentage Reduction (for premium reductions)
[ ] Description of Incentive Conditions
[ ] Qualified Medical Expense Reimbursement Compliance (Yes, No, N/A)
[ ] Date Incentive Program Established
[ ] IRS Safe Harbor Compliance (Select all that apply) (Good Faith, Non-discrimination testing, Written plan, No retaliatory effect)
[ ] Plan Document ID

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