Smoking Cessation Needs Survey for Owners and General Managers 2

1.

The purpose of this short, anonymous survey is to discover the needs of bar and restaurant owners and managers with regards to helping their employees quit smoking. Please help us design the most useful program possible! Thanks!

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Please tell us about your employees. Number of employees:
Number of employees that smoke during working hours:
Approximate number of smoking breaks taken by each employee per shift:
Approximate length of each smoking break (in minutes):

Smoking Cessation Needs Survey for Owners and General Managers 2

1.

1. My business is primarily a:

2. What is the average age of the majority of your employees?

3. Please tell us about your employees.

4. Do you have a health plan for your employees?

5. Would you be interested in helping your employees quit smoking wih a workplace smoking cessation program?