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2022 Wellness Activity Completion Form

  1. 2022 Wellness Program Scorecard

    Record your completion of the following activities during 1/1/22-12/30/22 and earn a $100 wellness incentive in January of 2023!  

    BONUS: Completion of activities 1 and 2 will earn your a $150 wellness incentive from TML Well. Visit for details.

    Activity completion submittal is due to Human Resources by 5 p.m. on Dec. 30, 2022. Please contact for questions.

    NOTE: Employees will receive $100 incentive via payroll deposit and will be considered taxable income by the IRS.

  2. I completed my Biometric Screening via (check one):*
  3. NOTE:

    Physician office visits will require you to enter the following results into the TML Well Portal: Height, Weight, Blood Pressure, Glucose, Total Cholesterol, HDL, LDL, Triglycerides

  4. 3. Additional Wellness Activities

    (Attach a doctor's note for Physician Office Visits)

  5. Acknowledgement*

    I understand the City of Anna may verify the information I provide. I understand if the City of Anna discovers at any time that I have failed to provide accurate information, appropriate action, up to and including termination as indicated within the City policies, may apply. 


  6. Leave This Blank:

  7. This field is not part of the form submission.