Smoke-Free Questionnaire
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The Smoke-free Task Force is working on a smoke-free policy and we value your opinion in answering the following eight questions.
Thank You!
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1
. Please indicate the following. I am a current
Please indicate the following. I am a current
Smoker
Non-Smoker
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2
. Which of the following best describes your place of work's official smoking policy?
Which of the following best describes your place of work's official smoking policy?
Allowed in designated smoking areas
Not allowed in any area
No official policy
Don't know/Not sure
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3
. Do you think that you would smoke fewer cigarettes a day if there were NOT a designated smoking area?
Do you think that you would smoke fewer cigarettes a day if there were NOT a designated smoking area?
Yes
No
Don't know/Not Sure
N/A
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4
. If a person has smoked a pack of cigarettes a day for more than 20 years, do you think there is any health benefit to quit smoking?
If a person has smoked a pack of cigarettes a day for more than 20 years, do you think there is any health benefit to quit smoking?
Yes
No
Don't know/Not sure
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5
. Do you think that breathing smoke from other people's cigarettes is:
Do you think that breathing smoke from other people's cigarettes is:
Very harmful to one's health
Somewhat harmful to one's health
Not very harmful to one's health
Not harmful at all to one's health
Don't know/Not sure
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6
. Would you want to work for an employer that has a smoke-free policy?
Would you want to work for an employer that has a smoke-free policy?
Yes
No
Don't know/Not sure
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7
. Would you choose a hospital that has a smoke-free policy for your health care?
Would you choose a hospital that has a smoke-free policy for your health care?
Yes
No
Don't know/Not sure
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8
. Do you think hospitals with smoke-free policies are setting an example of a healthy environment for employees, patients and visitors?
Do you think hospitals with smoke-free policies are setting an example of a healthy environment for employees, patients and visitors?
Yes
No
Don't know/Not sure
9
. Comments:
Comments:
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