ࡱ> IKH @ wbjbj00 ,.RRu.2228j,,.9V9X9X9X9X9X9X9$:R<|9|99UUU V9UV9UU66D 9 "sk$2"z7&V99097j=v=L 9..= 9LU|9|9.. 2K ..2Healthy Workplace Assessment Survey How healthy is your workplace? Choose the answer that best describes your work environment. While there are no right or wrong answers, thinking about, and answering these questions can help you point your workplace wellness program in the right direction. Smoking Is there a written smoke-free work environment policy? ( Yes ( No If yes, what is the extent of the ban? ( A partial ban on smoking (i.e. designated areas are smoke-free) ( Smoking allowed on the grounds but not in the building ( A total ban throughout the premises Is the policy posted or distributed to all employees? ( Yes ( No Are there any types of incentives for non-smokers or those who quit smoking? ( Yes ( No If yes, explain ______________________________________________ Does your organization offer on-site smoking cessation programs or self-help materials? ( Yes ( No Does your organization allow tobacco sales on site (i.e. vending machines, vendors)? ( Yes ( No Does your organization provide anti-smoking educational materials/messages to the general employee population? ( Yes ( No Nutrition Does your organization have vending machines for employees? ( Yes ( No If yes, Do vending machines provide labels indicating healthy foods? ( Yes ( No Has your organization ever contacted your vending company to request an increase in the number of healthier food selections? ( Yes ( No Does your organization have a cafeteria? ( Yes ( No If yes, Does the cafeteria provide labels indicating healthy foods? ( Yes ( No If your organization provides snacks at business functions/meetings are there nutritious choices? ( Yes ( No Physical Activity Does your organization provide a shower and changing facility for employees who want to exercise during off hours? ( Yes ( No Does your organization have an exercise facility on site? ( Yes ( No If yes, Do you subsidize membership fees? ( Yes ( No What percentage? _________ Is there credentialed staff to supervise activities? ( Yes ( No Is the facility open before and after work? ( Yes ( No Are employees required to complete an orientation to the exercise equipment ( Yes ( No Does your organization offer a corporate discount for employees to join a local exercise facility? ( Yes ( No Does your organization sponsor sports teams or events (corporate challenges) for employees? ( Yes ( No Does your organization provide any type of incentives for engaging in physical activity? ( Yes ( No If yes, indicate incentives: ______________________________________________________________________________________________________________________ Does your organization sponsor/organize a walking club? ( Yes ( No Does your organization offer on-site weight management programs? ( Yes ( No Does your organization offer any onsite physical activity classes (i.e. aerobics, yoga)? ( Yes ( No Stress Does your organization provide an employee assistance program (EAP)? ( Yes ( No Does your organization offer on-site stress management programs (i.e. videos/lectures pertaining to relaxation training, assertiveness, communication, time management)? ( Yes ( No Does your organization provide a non-smoking employee lounge, courtyard, or walking trail where employees can take a break? ( Yes ( No Does your organization offer other onsite convenience services (e.g. postal services, dry cleaning, and day care)? ( Yes ( No Does your organization allow flexible work scheduling policies (flextime/work at home)? ( Yes ( No Screenings Does your organization provide on-site blood pressure screenings? ( Yes ( No Does your organization provide on-site cholesterol screenings? ( Yes ( No Does your organization provide health risk assessments? ( Yes ( No Does your organization have onsite medical staff? 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