Steps to Health Registration 2021

1. HSE Steps to Health Challenge 2021

Welcome to the Registration for the Steps to Health Challenge. With the ongoing public health restrictions due to COVID-19 we will try our best to make the challenge fun and beneficial to all who participate. While some of our staff are never off their feet, many may be finding it difficult to reach their usual levels of physical activity, particularly those working from home. The Steps to Health Challenge runs for five weeks, supporting staff to move more and count your steps daily so that you can record your improvements over time.
Due to COVID-19 we all have to be mindful of social distancing. So we will continue with teams of between 2 and 10 participants, including your team co-ordinator. We encourage you to join up as part of a virtual team if you will be working from home during the challenge and suggest you walk and be active with just one colleague at a time if you are in a workplace.
The Challenge is a workplace initiative open to HSE, Tusla, Department of Health, Safefood and others working in related health service organisations.
Follow us during the challenge on Twitter @hsesteps using #HSEstepschallenge
To register a team, please have the team co-ordinator complete the registration form below.

1. What is your team's name for the Challenge? (Be creative we will have prizes for the best team name) *

2. What is your team co-ordinators's name? *

3. Have you been a team co-ordinator previously? Please choose all applicable options

4. If you work within a HSE Community Health Organisation please select which one from the drop down menu below. *

	Select which CHO
Community Health Organisation	Community Health Organisation Select which CHO

5. If you work within a Hospital Group please select which one from the drop down menu below. *

	Select which Group
Hospital Group	Hospital Group Select which Group

6. If you do not work in a CHO or Hospital Group please select from the options below *

Already answered question 4 or 5 (CHO or Hospital Group)
HSE National Service
TUSLA
Other (please specify):

7. Please provide team co-ordinator's contact address (please be specific as it is required for delivery of resources) *

Address 1	*
Address 2	*
Address 3	*
Address 4	*
County	*
Eircode (please see www.eircode.ie)	*

8. Team co-ordinator's phone number (we need this to deliver your team's resource pack) *

9. Team co-ordinator's e-mail address (Please ensure email addresses match) *

Email Address	*
Confirm Email	*

10. How many participants are in your team? (This year a maximum of 10 participants per team is allowed) *

	Number
Number of participants on team	Number of participants on team Number

11. Some participants may already have a step counter from previous challenges, a smart watch, for example a FitBit, or a phone app. Taking this into account, how many step counters do you require for your team for this year's challenge? *

	Number
Amount of step counters required	Amount of step counters required Number

12. Do you consent to your personal information being shared with Health and Wellbeing for other staff Health and wellbeing initiatives? *

Yes
No

13. Do you consent to the Steps to Health team keeping your contact details for future Steps to Health challenges? *

Yes
No