BRIGHT Healthiest Workplace Competition

Instructions for Completion:

Please answer "yes" or "no" for each question on the survey. All questions should be answered consistently based on worksite practices and programs that are currently in place (i.e., on-going activities, services) or have occurred within the last 12 months (e.g., annual 12-week walking challenges).

There are multiple sections to the assessment tool; you may complete each section in separate sittings. Your answers will be automatically saved when you click ">>" and you will be taken back to the last section completed when opening the survey subsequent times.

During the first portion of the survey, you will be asked to provide demographic information pertaining to your workforce. Answering these questions will require you to obtain specific information regarding the number of employees.

Portions of this survey are from the Centers for Disease Control and Prevention. The CDC Worksite Health ScoreCard: An Assessment Tool for Employers to Prevent Heart Disease, Stroke, and Related Health Conditions. Atlanta: U.S. Department of Health and Human Services; 2012.

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* 1. Name

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* 2. Job Title

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* 3. Department

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* 4. Address (Street, City, Zip Code)

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* 5. Telephone Number

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* 6. Email Address

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* 7. Approximately how many full-time employees are currently
employed at your workplace?

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* 8. Which best describes your organization's business type?

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* 9. Which best describes your organizations industry type?

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* 10. Does your organization have a wellness program?

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* 11. How many years has your organization offered the wellness
program?

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* 12. Do you intend to start a worksite wellness program?

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* 13. When do you anticipate starting a wellness program at your
worksite?

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* 14. Which elements of worksite health promotion programs are offered at your organization (select all that apply)?

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* 15. Since you chose "other", please explain what other elements of worksite health promotion programs are offered at your organization:

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* 16. During the last 12 months, did your worksite:

Conduct an employee needs and interests assessment for planning health promotion activities?

Answer "yes" if, for example, your organization administers focus groups or employee satisfaction surveys to assess your employee health promotion program(s). Answer "no" if your organization administers general surveys that do not assess your employee health promotion program(s).

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* 17. During the last 12 months, did your worksite:

Conduct employee health risk appraisals/assessments through vendors, on-site staff, or health plans and provide individual feedback plus health education?

Answer "yes" if, for example, your organization provides individual feedback through written reports, letters, or one-on-one counseling.

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* 18. During the last 12 months, did your worksite:

Demonstrate organizational commitment and support or worksite health promotion at all levels of management?

Answer "yes" if, for example, all levels of management participate in activities, communications are sent to employees from senior leaders, the worksite supports performance objectives related to healthy workforce, or program ownership is shared with all staff levels.

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* 19. During the last 12 months, did your worksite:

Use and combine incentives with other strategies to increase
participation in health promotion programs?

Answer “yes” if, for example, your organization offers incentives such as gift certificates, cash, paid time off, product or service discounts, reduced health insurance premiums, employee recognition, or prizes.

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* 20. During the last 12 months, did your worksite:

Use competitions when combined with additional interventions to support employees making behavior changes?

Answer “yes” if, for example, your organization offers walking or weight loss competitions.

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* 21. During the last 12 months, did your worksite:

Promote and market health promotion programs to employees?

Answer “yes” if, for example, your worksite’s health promotion
program has a brand name or logo, uses multiple channels of
communication, or sends frequent messages.

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* 22. During the last 12 months, did your worksite:

Use examples of employees role modeling appropriate health
behaviors or employee health-related “success stories” in the
marketing materials?

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* 23. During the last 12 months, did your worksite:

Tailor some health promotion programs and education materials to the language, literacy levels, culture, or readiness to change of various segments of the workforce?

Answer “no” if you do not perceive a need for your organization to tailor its health promotion programs and education materials to any specific group(s).

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* 24. During the last 12 months, did your worksite:

Have an active health promotion committee?

Answer “yes” if your health promotion committee exists and has been involved in planning and implementing programs.

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* 25. During the last 12 months, did your worksite:

Have a paid health promotion coordinator whose job (either
part-time or full-time) is to implement a worksite health
promotion program?

Answer “yes” if implementing the employee health promotion
program(s) at your worksite is included in a paid staff member’s job description or performance expectations.

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* 26. During the last 12 months, did your worksite:

Have a champion(s) who is a strong advocate for the health
promotion program?

Answer “yes” if there is someone at your worksite who actively
promotes programs to improve worksite health promotion.

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* 27. During the last 12 months, did your worksite:

Have an annual budget or receive dedicated funding for health
promotion programs?

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* 28. During the last 12 months, did your worksite:

Set annual organizational objectives for health promotion?

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* 29. During the last 12 months, did your worksite:

Include references to improving or maintaining employee health in the business objectives or organizational mission statement?

Answer “no” if your organization’s business objectives or mission statement only reference occupational health and safety, without reference to improving the workforce’s health.

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* 30. During the last 12 months, did your worksite:

Conduct ongoing evaluations of health promotion programming that use multiple data sources?

Answer “yes” if, for example, your organization collects data on employee health risks, medical claims, employee satisfaction, or organizational climate surveys.

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* 31. During the last 12 months, did your worksite:

Make any health promotion programs available to family
members?

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* 32. During the last 12 months, did your worksite:

Provide flexible work scheduling policies?

Answer “yes” if, for example, policies allow for flextime schedules and work at home.

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* 33. During the last 12 months, did your worksite:

Engage in other health initiatives throughout the community
and support employee participation and volunteer efforts?

Answer “yes “if, for example, your organization supports
participation in community events and school-based efforts, such as corporate walks, collaborate with state and local advocacy groups, health and regulatory organizations, and coalitions.

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* 34. During the last 12 months, did your worksite:

Have a written policy banning tobacco use at your worksite?

Answer “yes” if your worksite adheres to a statewide, county wide, or citywide policy banning tobacco use in the workplace.

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* 35. During the last 12 months, did your worksite:

Actively enforce a written policy banning tobacco use?

Answer “yes” if, for example, your worksite posts signs, does not have ashtrays, or communicates this written policy banning tobacco use through various channels at your worksite.

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* 36. During the last 12 months, did your worksite:

Display signs (including ‘no smoking’ signs) with information
about your tobacco-use policy?

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* 37. During the last 12 months, did your worksite:

Refer tobacco users to a state or other tobacco cessation telephone quit line?

Answer “yes” if, for example, your worksite refers tobacco users to 1-800-QUIT NOW or smokefree.gov.

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* 38. During the last 12 months, did your worksite:

Provide health insurance coverage with no or low out-of-pocket costs for prescription tobacco cessation medications including nicotine replacement?

Answer “yes” if, for example, your organization provides coverage for inhalers, nasal sprays, bupropion (e.g., Zyban) and varenicline (e.g., Chantix).

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* 39. During the last 12 months, did your worksite:

Provide health insurance coverage with no or low out-of-pocket costs for FDA-approved over-the-counter nicotine replacement products?

Answer “yes” if, for example, your organization provides coverage for nicotine replacement gum, patches, or lozenges.

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* 40. During the last 12 months, did your worksite:

Provide or promote free or subsidized tobacco cessation
counseling?

Answer “yes” if these programs are provided on- or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.

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* 41. During the last 12 months, did your worksite:

Inform employees about health insurance coverage or programs that include tobacco cessation medication and counseling?

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* 42. During the last 12 months, did your worksite:

Provide incentives for being a current nonuser of tobacco and for current tobacco users that are currently involved in a cessation class or actively quitting?

Answer “yes” if, for example, your organization provides discounts on health insurance, increases in disability payments or additional life insurance for non-smokers and tobacco users who are actively trying to quit

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* 43. During the last 12 months, did your worksite:

Do not allow sale of tobacco products on company property

Answer “yes” if, for example, your worksite does not sell tobacco products on company property in vending machines or through on-site vendors

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* 44. During the last 12 months, did your worksite:

Provide places to purchase food and beverages?

Answer “yes” if, for example, your worksite provides vending machines, cafeterias, snack bars, or other purchase points.

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* 45. During the last 12 months, did your worksite:

Have a written policy or formal communication that makes
healthier food and beverage choices available in cafeterias or snack bars?

Answer “yes” if, for example, the policy or formal communication makes vegetables, fruits, 100% fruit juices, whole grain items and trans fat-free or low-sodium snacks available in cafeterias or snack bars.

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* 46. During the last 12 months, did your worksite:

Have a written policy or formal communication that makes
healthier food and beverage choices available in vending machines?

Answer “yes” if, for example, the policy or formal communication makes vegetables, fruits, 100% fruit juices, whole grain items and trans fat-free/low-sodium snacks available in vending machines.

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* 47.  During the last 12 months, did your worksite:

Make most (more than 50%) of the food and beverage choices
available in vending machines, cafeterias, snack bars, or other
purchase points be healthier food items?

Answer “yes” if the healthy foods are items such as skim milk,
1% milk, water, unsweetened flavored water, diet drinks, 100%
fruit juice, low-fat and low-sodium snacks, or fresh fruit. (See
Dietary Guidelines for Americans, 2010, or GSA/HHS Health
and Sustainability Guidelines for Federal Concessions and Vending Operations.)

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* 48. During the last 12 months, did your worksite:

Provide nutritional information (beyond standard nutrition
information on labels) on sodium, calories, trans fats, or saturated
fats for foods and beverages sold in worksite cafeterias, snack bars, or other purchase points?

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* 49.   During the last 12 months, did your worksite:

Identify healthier food and beverage choices with signs or symbols?

Answer “yes” if, for example, your worksite puts a heart next to a healthy item near vending machines, cafeterias, snack bars, or other purchase points.

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* 50. During the last 12 months, did your worksite:

Subsidize or provide discounts on healthier foods and beverages offered in vending machines, cafeterias, snack bars, or other purchase points?

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* 51. During the last 12 months, did your worksite:

Have a written policy or formal communication which makes
healthier food and beverage choices available during meetings
when food is served?

Answer “yes” if, for example, the policy or formal communication makes vegetables, fruits, 100% fruit juices, whole grain items or trans fat-free/low-sodium snacks available during meetings.

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* 52. During the last 12 months, did your worksite:

Provide employees with food preparation and storage facilities?

Answer “yes” if your worksite provides a microwave oven, sink, refrigerator, or kitchen.

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* 53. During the last 12 months, did your worksite:

Offer or promote an on-site or nearby farmers’ market where fresh fruits and vegetables are sold?

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* 54. During the last 12 months, did your worksite:

Provide brochures, videos, posters, pamphlets, newsletters, or other written or on-line information that address the benefits of healthy eating?

Answer “yes” if these health promotion materials address the
benefits of healthy eating as a single health topic or if the benefits of healthy eating are included with other health topics.

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* 55. During the last 12 months, did your worksite:

Provide a series of educational seminars, workshops, or classes on nutrition?

Answer “yes” if these sessions address nutrition as a single health topic or if nutrition is included with other health topics. These sessions can be provided in-person or on-line; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.
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* 56. During the last 12 months, did your worksite:

Provide free or subsidized self-management programs for healthy eating?

Answer “yes” if these programs are provided in-person or on-line; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans and programs, community groups, or other practitioners.

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* 57. During the last 12 months, did your worksite:

Provide an exercise facility on-site?

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* 58. During the last 12 months, did your worksite:

Subsidize or discount the cost of on-site or off-site exercise facilities?

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* 59. During the last 12 months, did your worksite:


Provide other environmental supports for recreation or physical activity?


Answer “yes” if, for example, your worksite provides trails or a track for walking/jogging, maps of suitable walking routes, bicycle racks, a basketball court, open space designated for recreation or exercise, a shower and changing facility.

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* 60. During the last 12 months, did your worksite:


Post signs at elevators, stairwell entrances or exits and other key locations that encourage employees to use the stairs?


Answer “no” if your worksite is located in a one-story building.

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* 61. During the last 12 months, did your worksite:

Provide organized individual or group physical activity programs for employees (other than the use of an exercise facility)?


Answer “yes” if, for example, your worksite provides walking orstretching programs, group exercise, or weight training.

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* 62. During the last 12 months, did your worksite:


Provide brochures, videos, posters, pamphlets, newsletters, or other written or on-line information that address the benefits of physical activity?


Answer “yes” if these health promotion materials address the benefits of physical activity as a single health topic or if the benefits of physical activity are included with other health topics.

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* 63. During the last 12 months, did your worksite:


Provide a series of educational seminars, workshops, or classes on physical activity?


Answer “yes” if these sessions address physical activity as a single health topic or if physical activity is included with other health topics. These sessions can be provided in-person or on-line; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.

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* 64. During the last 12 months, did your worksite:

Provide or subsidize physical fitness assessments, follow-up
counseling, and physical activity recommendations either on-site or through a community exercise facility?

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* 65. During the last 12 months, did your worksite:


Provide free or subsidized self-management programs for physical activity?

Answer “yes” if these programs are provided in-person or on-line; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.

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* 66. During the last 12 months, did your worksite:

Provide free or subsidized body composition measurement, such as height and weight, Body Mass Index (BMI) scores, or other body fat assessments (beyond HRAs) followed by directed feedback and clinical referral when appropriate?

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* 67. During the last 12 months, did your worksite:

Provide brochures, videos, posters, pamphlets, newsletters, or other written or on-line information that address the risks of overweight or obesity?


Answer “yes” if these health promotion materials address the risks of overweight or obesity as a single health topic or if the risks of overweight or obesity are included with other health topics.

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* 68. During the last 12 months, did your worksite:


Provide a series of educational seminars, workshops, or classes on weight management?

Answer “yes” if these sessions address weight management as a single health topic or if weight management is included with other health topics. These sessions can be provided in-person or on-line; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.

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* 69. During the last 12 months, did your worksite:


Provide free or subsidized one-on-one or group lifestyle counseling for employees who are overweight or obese?


Answer “yes” if these programs are provided in-person or on-line; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.

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* 70. During the last 12 months, did your worksite:

Provide free or subsidized self-management programs for weight management?

Answer “yes” if these programs are provided in-person or on-line; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.

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* 71. During the last 12 months, did your worksite:

Have a written policy on breastfeeding?

Answer "yes" if the policy is included as a component of other employee policies or is a separate policy related to breastfeeding.

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* 72. During the last 12 months, did your worksite:

Provide a private space (other than a restroom) that may be used by an employee to express breast milk?

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* 73. During the last 12 months, did your worksite:

Provide access to a breast pump at the worksite?

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* 74. During the last 12 months, did your worksite:

Provide flexible break times to allow mothers to pump breast milk?

Answer "yes" if flexible break times were provided, whether paid or unpaid.

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* 75. During the last 12 months, did your worksite:

Provide free or subsidized breastfeeding support groups or educational classes?

Answer "yes" if these sessions address breastfeeding as a single health topic or if breastfeeding is included with other health topics. These sessions can be provided in-person or on-line; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners.

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* 76. During the last 12 months, did your worksite:

Offer paid maternity leave, separate from any other accrued leave?

Answer "no" if employees may take paid maternity leave using only accrued leave such as sick or annual leave time.

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