Important announcement on Preventative Exam:  In most situations, the employee will only have to complete a Preventative Exam every other year.  If the "return date" (filled in by the doctor--or one year) is after June 1, the employee will be given credit for the next school year.  If you complete your exam yearly, complete the form each year.  

Preventative Exam form

All employees are offered an incentive for completing a Preventative Exam.  There are five requirements to complete or be current (up to date) on the following:

  1. Complete a physical examination from a physician based on age, gender and risk factors.
  2. Complete physician recommended preventative cancer screenings based on age, gender, and genetic risk factors. i.e. mammogram, pap smear, colonoscopy, etc.
  3. Complete a blood chemistry panel within the last 5 years.  More frequent if physician recommends based on risk factors.   Screened items are:  Glucose levels, LDL cholesterol, total cholesterol, and triglycerides.  Patient should receive this information.  
  4. Discuss immunization status.
  5. Discuss recommendations to address present risk factors.  These recommendations should include any prudent professional interventions (i.e. prescriptions) and lifestyle changes (activity and dietary changes).    

Return the signed Employer’s copy of the Preventative Exam form the "Wellness Office" or John Allan at the District Office via IMC, mail or hand delivery.  Copies, images and facsimiles are accepted.   Email: john.allan@nebo.edu  Fax: 801-342-8023. 

Incentives for completion:

Employees enrolled on Nebo Health insurance:  Completes the Preventative Exam requirement for both the Road to Wellness (avoid $200 pay deduction) and for the Gimme 5 Wellness Prize ($50 gift card, Fit watch, RTIC water bottle set or Wellness Day).   Remember to take the personal health assessment to complete the Road to Wellness

Employee eligible for Nebo District insurance but not enrolled:  Completes the Preventative Exam requirement for Gimme 5 Wellness Prize ($50 gift card, Fit watch, RTIC water bottle set or Wellness Day).

Employees not eligible for Nebo health insurance:  Complete this form and return to the Wellness Office at the District Office to receive a $35 gift card. To qualify:  Must work at least 2 hours a day.  Retirees, employees under 18, seasonal and substitutes not eligible.

Spouses on District Health Insurance:  Complete this form and return to the Wellness Office at the District Office to receive a $35 gift card.  All other spouses are NOT eligible for the $35 gift card.