ࡱ> DFC@ #bjbjצצ <<<<<$$$8\xDw"!!!!!!!$-#R%""<<1"w w w <8!w !w w V!@t! 2$! !G"0w"! &K  &!<<<< &!w ""$g $Work Environment Assessment Please answer all questions based on the last 12 months within your organization. WORKSITE DEMOGRAPHICS Please indicate which corresponds to your organizations primary industry? Manufacturing Labor Consumer/Retail Schools Health Care/Hospitals Higher Education/Non-Profit Entity Government/Regulated Industry Other: ____________________ About what percent of the workforce is unionized? ( 0% ( 1-25% ( 26-50% ( 51-75% ( 76-100% How many full-time employees does your organization have? __________ How many part-time or seasonal employees does your organization have? __________ Are part-time/seasonal employees eligible for medical benefits? _________ What is the average employee age? _________ What is the gender ratio? % Male ________ % Female __________ Does your organization have any language or other cultural barriers that would prohibit wellness? ( Yes ( No If yes, What are the primary languages spoken? ______________________________________________________________________________________________________________________ Does your organization provide translation services? ( Yes ( No What is your peak season? Winter Spring Summer Fall If more than one location, please break down employee count by location. Location #1 __________________ Employees _____________ Location #2 __________________ Employees _____________ Location #3 __________________ Employees _____________ Does your organization have shift work? Shift start time ________ Break ________ Shift end time ____________ Shift start time ________ Break ________ Shift end time ____________ Shift start time ________ Break ________ Shift end time ____________ Does your organization provide flexible work scheduling policies (flextime/work at home)? ( Yes ( No 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 If yes, do you promote Independence Blue Cross Healthy Lifestyles Smoking Cessation reimbursement program? ( 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 Does your organization subsidize or provide free food options for employee meetings? ( Yes ( No If yes, ( Provide nutritious food options (apples, juices, popcorn, etc..) ( Provide non-nutritious food options (donuts, cakes, soda, etc..) 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? _________ Are there credentialed staff to supervise activities? ( Yes ( No Is the facility open before and after work? ( 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 classes (i.e. aerobics, yoga)? ( Yes ( No Does your organization promote Independence Blue Cross Healthy Lifestyles Weight Management/Fitness reimbursement programs? ( 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 SCREENINGS Does your organization provide on-site blood pressure screenings? ( Yes ( No Does your organization provide on-site blood screenings (cholesterol, glucose)? ( Yes ( No Does your organization provide health risk assessments? ( Yes ( No ADMINISTRATIVE Does your organization have a wellness committee? ( Yes ( No If yes, Does it meet at least quarterly? ( Yes ( No Does it include one senior manager? ( Yes ( No Does it have a written mission statement? ( Yes ( No Does it have a budget? ( Yes ( No Is it a standing committee? ( Yes ( No Does your organization have an individual responsible for the delivery/oversight of a health promotion/wellness program? ( Yes ( No Does your organization have onsite medical staff? ( Yes ( No Does your organization provide general health improvement messages to the employee population through posters, brochures, newsletters, videos, lectures, etc..? ( Yes ( No If yes, how? ____________________________________________ Does senior management support worksite health promotion through an annual message to employees (memo, personal address, newsletter article)? ( Yes ( No Does your organizations worksite program have a theme, logo, or name? ( Yes ( No Does your organization have a conference room to conduct programs? ( Yes ( No Does your organization offer other onsite convenience services (i.e. postal services, dry cleaning, day care)? ( Yes ( No Other important information about your organization: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ o | }  ".5Z[bci lmvwuv}~]^ef23:;AJ$6CJOJQJ jCJOJQJ5CJOJQJ CJOJQJCJ5CJUop 6 T p q   l m  & F$a$### * + E F A y "i  & F^` "#hi 45|}u]kl`h^hh`hl2@AJ*+bcl "*p^`$%UV\]cl"*,-rs?@GH'(/0efmnDELM/078 Z[bch5CJOJQJ CJOJQJ jCJOJQJ[MN5rsDRSPQ^`/=>%&Zhitu()pqhs"#bcjkp%&-._`ghmDELM4 5 ; < B | ! !!!`!a!g!h!!!!!/"0"7"8"### j6 jCJOJQJ CJOJQJ5CJOJQJL3mDRS4 A B | } !!!`!m!n!!!!`!/"=">"s"####### / =!"#$%8@8 Normal_HmH sH tH @@@ Heading 1$@& CJOJQJD@D Heading 2$@&5CJOJQJN@N Heading 3$@&`56CJOJQJH@H Heading 4$@&` CJOJQJF@F Heading 5$$@&a$ CJ(OJQJL@L Heading 6$@&`5CJOJQJDAD Default Paragraph FontViV  Table Normal :V 44 la (k(No List :B@: Body Text CJOJQJ4@4 Header  !4 @4 Footer  !>'!> Comment ReferenceCJ424  Comment TextBP@BB Body Text 25CJOJQJ<op6Tpqlm*+EF Ay"i "#hi 45|}  u ] k l 2 @ A J * + b c l " * p MN5rsDRSPQ/=>%&Zhitu()pq3mDRS4AB|} `mn/=>s00000x00 0 0 0 0 0 0 0 000000000000 00 00 00 00x0x0x0x0x 0x 0 0 000x0000000x0x0x0x0x0x0x0x0x0x000000000x00x0x00x0x0000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000(00008000000000000X000000000000000000?0\>0$h# l!##8@0(  B S  ?o&2^j:Bl o  333333333ooPxX\ $U0| /^`/o(.hh^h`o(. hh^h`OJQJo(PxX\$U0o@l$DP@UnknownGz Times New Roman5Symbol3& z Arial"1h;F왆st&"2"2!4d3H?Work Climate SurveyIndependence Blue Crossc62cj43   Oh+'0  8 D P \hpxWork Climate SurveyorkIndependence Blue Crossnde Normal.dotec62cj4332cMicrosoft Word 10.0@Ik@O@: k@'2"՜.+,D՜.+,T hp  Independence Blue Cross2O Work Climate Survey Title4@(_AdHocReviewCycleID_EmailSubject _AuthorEmail_AuthorEmailDisplayName_ReviewingToolsShownOnce|  Web ContentGeneva.Jackson@ibx.comeJackson, Genevaack  !"#$%&'()*+,-./012456789:<=>?@ABERoot Entry F/2G1Table#&WordDocument<SummaryInformation(3DocumentSummaryInformation8;CompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q