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ATTACHMENT C <br />Officer Wellness & Readiness Incentive Verification Form <br />Wellness Incentive Vacation Credit <br />Employee Name: Calendar Year: <br />Submission Deadline: November 15 <br />Total Wellness Incentive Vacation Credit Requested: / 12 hours <br />Employees may earn uo to three hours in each category, for a maximum of twelve hours per <br />calendar year. Each completed category is worth three hours of Wellness Incentive Vacation <br />Credit. <br />1. Physical Readiness - 3 Hours <br />Complete one of the following: <br />❑ Seventy-eight documented workouts or fitness activities <br />❑ One approved fitness challenge. race. workout program. or wellness program <br />❑ One meeting with a fitness coordinator or wellness designee. along with a personal fitness <br />plan <br />D Other approved activity: <br />Brief description. if needed: <br />Credit Requested: ❑ 3 hours <br />2. Mental & Emotional Resilience - 3 Hours <br />Complete four approved activities: <br />❑ Mindfulness or reflective iournaling <br />❑ Meditation. breathing exercises, or stress -management practice <br />❑ Sleep iournaling or sleep -health education <br />❑ Read an approved wellness, resilience, leadership, or law -enforcement wellness book <br />❑ Listened to an approved wellness -related nodcast <br />❑ Met with a chaplain. peer support member, counselor. or other wellness resource <br />❑ Participated in approved resiliency. peer support, or emotional wellness training <br />D Other approved activity: <br />Brief description. if needed: <br />Credit Requested: ❑ 3 hours <br />3. Whole Health & Life Balance - 3 Hours <br />Complete three approved activities: <br />❑ Annual preventive health examination <br />❑ Annual dental examination <br />