Build a non-diagnostic health risk screening checklist for a workplace wellness program

You are building a self-report health risk screening checklist for a workplace or community wellness program. The checklist's only job is to help someone notice patterns worth raising with a clinician — it must never produce a risk score, label, or verdict about an individual's actual health status.

PROGRAM CONTEXT
An annual voluntary wellness screening event at a mid-size company, self-administered on paper.

RISK AREAS TO COVER
Sleep quality, stress levels, physical activity frequency, and family history awareness.

HOW RESULTS WILL BE USED
Kept entirely by the individual — not collected or reported to HR or the employer in any form.

AUDIENCE
Adult employees across a wide age range, mixed health literacy, completing it voluntarily on their own time.

RULES
Write each checklist item as a plain factual question about a behavior, symptom frequency, or history ("in the past month, how many days did you...") rather than a question that requires the person to already have interpreted their own risk ("do you have high blood pressure risk"). Group items by risk area, and after each group, write a plain instruction for what a person should do with a pattern of "yes" or concerning answers in that group — always "consider discussing this with a doctor," never a score, tier, or label like "moderate risk" or "high risk," since assigning a risk tier from a self-report checklist without clinical context is exactly the kind of judgment this tool should not make. Keep the checklist anonymous-compatible by design — do not require or reference anything that would only make sense if results were being centrally scored or ranked against other participants, since that shifts the tool from self-reflection aid toward something that resembles a clinical assessment.

WHAT NOT TO DO
Do not include a scoring formula, point system, or cutoff threshold anywhere in the checklist, even one you're inclined to add for user-friendliness — an unscored checklist that prompts a conversation is safer and more accurate than a scored one that implies a false level of diagnostic precision.

MANDATORY DISCLAIMER
Open the checklist with a note stating plainly that this is a self-reflection tool, not a medical screening or diagnostic instrument, that it does not calculate a risk score, and that any pattern of concerning answers should be discussed with a qualified clinician, who is the only one positioned to actually assess health risk.

OUTPUT FORMAT
1. The disclaimer.
2. Checklist items grouped by risk area, each as a plain yes/no or frequency question.
3. After each group, the plain instruction line ("if you answered yes to several of these, consider raising it with your doctor").
4. A closing line restating that this checklist doesn't score or diagnose anything.