2023 OK Certified Family Positive Workplace Application

Employers are recognizing that employees are the critical difference between good businesses and great businesses. They are also realizing that employees have lives outside of the workplace are now wanting and expecting a workplace that allows a work/life balance. It's an expectation that businesses that want to attract and keep talent understand and take steps to accommodate these needs.

By creating a Family Positive Workplace environment, businesses increase employee loyalty and morale and contribute to families raising children who will become better students, employees, and citizens. Companies that provide such practices strengthen their community image, boost recruitment, retain their workforce, improve productivity, and help to raise the bar for other businesses.

Become part of this movement and join others in changing business practices to better our families and communities.

Family Positive Workplace Certification is a way to differentiate your company and showcase it as a place where employees are supported. Certification helps recruit and retain employees and creates a workplace that invests in your employees by caring about the needs of their families. Policies that promote work-life balance increase employee loyalty and positively impact communities as a whole.

We welcome and encourage all companies to apply! There is no definition of “family” within this program. We know families come in all shapes and sizes, as do companies and organizations.

Please visit Oklahoma Certified Family Positive Workplace to find more detailed application information and complete the online application. For questions or more information, please contact Linda Manaugh at (405) 486-4955 or lmanaugh@pottsfamilyfoundation.org.

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* 1. Business Name

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* 2. # of Employees

1 - 25

26 - 100

101 - 200

201 - 300

301 - 400

400 - 500

500 - 600

700 - 1,000

over 1,000

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* 3. Street Address

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* 4. City

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* 5. State

Oklahoma

Other (please specify)

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* 6. Zip

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* 7. Contact Person

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* 8. Position

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* 9. E-Mail Address

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* 10. Phone:

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* 11. Secondary Contact

Name

Email Address

Phone Number

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* 12. Secondary Contact

Name

Email Address

Phone Number

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* 13. Type of Business:

For Profit

Not for Profit

Government

Other

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* 14. If you selected other on the previous question please specify.

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* 15. Please provide a short description of your company:

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* 16. How did you hear about Family Positive Workplace?

Potts Family Foundation Website

Facebook

Family Positive Workplace Workshop

Other

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* 17. If you selected other on the previous question please specify.

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* 18. Are you a past FPW company reapplying?

Yes

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* 19. Check the Workplace Flexibility options your business provides

Flextime vs. Specific Hours - Flextime is an arrangement that allows an employee to alter the start and end times of their workday regular schedule of 8:00 am to 5:00 pm. Flextime does not reduce the total number of hours worked in a given workweek.

Compressed Workweek - An alternative work arrangement where a standard workweek is reduced to fewer than five days, and employees make up the full number of hours per-week by working longer days.

Work from Home/Telecommuting - A work arrangement in which the employee works outside the office, often working from home or a location close to home. Rather than traveling to the office, the employee “travels” via telecommunication links, keeping in touch with coworkers and employers via telephone and email.

Flexible Lunch and Break Times

Job Sharing Options - A flexible work option in which two or possibly more employees share a single job.

Part-Time Work

Time Off During Work Day for Family Matters

Please choose to answer EITHER the "Vacation, Sick or other Leave" section OR the "Paid/Personal Time Off (PTO)" Section

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* 20. If your company provides Vacation, Sick or other leave, check the options your business provides

Paid Vacation

Unpaid Vacation

Paid Sick Leave

Unpaid Sick Leave

Paid School Holiday Leave

Unpaid School Holiday Leave

Paid Family Medical Leave - Provides employees with 12 work weeks of leave in a 12 month period for the birth of a child and caring for the child within one year of birth; the placement with the employee of a child for adoption or foster care for the newly placed child within one year of placement; to care for the employee’s spouse, child, or parent who has a serious health condition; a serious health condition that makes the employee unable to perform the essential functions of their job; any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty”; or 26 workweeks of leave during a single 12-month period to care for a covered service member with a serious injury or illness if the eligible employee is the service-member’s spouse, son, daughter, parent, or next of kin (military caregiver leave).
Source: https://www.dol.gov/whd/fmla/

Unpaid Family Medical Leave - Provides employees with 12 workweeks of leave in a 12 month period for the birth of a child and caring for the child within one year of birth; the placement with the employee of a child for adoption or foster care for the newly placed child within one year of placement; to care for the employee’s spouse, child, or parent who has a serious health condition; a serious health condition that makes the employee unable to perform the essential functions of their job; any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty”; or 26 workweeks of leave during a single 12-month period to care for a covered service member with a serious injury or illness if the eligible employee is the service member’s spouse, son, daughter, parent, or next of kin (military caregiver leave).

Paid Extended Family Medical Leave

Unpaid Extended Family Medical Leave

Paid Family/Elder/Child Caregiver Leave

Unpaid Family/Elder/Child Caregiver Leave

Paid Time Off for Adoption/Fostering

Unpaid Time Off for Adoption/Fostering

Paid Time Off for Sick Child Care

Unpaid Time Off for Sick Child Care

Paid Parental Leave

Unpaid Parental Leave

Paid Bereavement Leave

Unpaid Bereavement Leave

Paid Time Off for Parent/Teacher Conferences

Unpaid Time Off for Parent/Teacher Conferences

Paid Time Off for School Events

Unpaid Time Off for School Events

Sick Leave Bank or Sharing - Sick Leave Bank provides paid sick leave to qualifying members who are medically certified as unable to perform the duties of their jobs as a result of a personal illness, injury, accident, disability, medical condition, or quarantine and who have exhausted all their personal annual, compensatory, and sick leave balances. Sick leave sharing is a leave-sharing program that allows an employee to donate accrued hours of paid vacation, or personal and potentially sick leave for the benefit of other employees who need to take more leave than they have available.

Post Maternity Phase Back - This is meant to ease the return to work for new mothers. This policy may include allowing women to split up their maternity leave instead of taking it all at once or offering new mothers access to a more family-friendly schedule, if temporarily, as part of a more holistic maternity leave package.
Source: https://www.washingtonpost.com/news/on-leadership/wp/2015/05/07/a-smart-way-to-ease-mothers-return-to-work-after-maternity-leave/?utm_term=.4c01f0c3aef9

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* 21. If your company provides Paid/Personal Leave (PTO), check the options your business offers. Employees may use PTO for vacation, illness, injury, or personal business.

Paid/Personal Time Off – An employee may use PTO for vacation, illness, injury or personal business

Unpaid/ Personal Time OFF - and employee may use unpaid Personal Time Off or request unpaid leave for: Sick Leave, Family Medical Leave, Maternity/Paternity Leave, Elder Care/Caregiver Leave, Time Off for Adoption, Time Off for Sick Child Care, School Holiday Leave and school conference meetings

Sick Leave

Family Medical Leave

Maternity/Paternity Leave · This is the period of time when a parent stops working because they are about to have, or just had (or adopted) a baby. Maternity/Paternity leave protects the employee's job for up to 12 weeks after a birth or adoption. This policy means that new mothers/fathers are entitled to return to their positions after a period of absence without penalty in pay or position. This policy does require payment during the 12 week period and may only apply to employees who have worked a certain number of hours as established by policy.

Source: https://thebenefitsguide.com/elderly-care-benefits-offer-caregiver-employees/

Elder Care/Caregiver Leave

Time Off for Adoption

Time Off for Sick Child Care

School Holiday Leave

Bereavement Leave

Time Off for Parent/Teacher Conferences

Time Off for School Events

PTO Bank or Sharing

Post Maternity Phase Back - This is meant to ease the return to work for new mothers. This policy may include allowing women to split up their maternity leave instead of taking it all at once or offering new mothers access to a more family-friendly schedule, if temporarily, as part of a more holistic maternity leave package.
Source: https://www.washingtonpost.com/news/on-leadership/wp/2015/05/07/a-smart-way-to-ease-mothers-return-to-work-after-maternity-leave/?utm_term=.4c01f0c3aef9

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* 22. Check the Employee Benefit options your business provides (Health) - This is an employee welfare benefit plan established or maintained by the employer that includes care for participants or their dependents directly or through insurance, reimbursement, or otherwise.

To calculate the percentage of premium paid by the employer, divide the employer paid monthly premium by the total monthly premium to get X number. Then multiply that number by 100 to obtain the exact percentage premium paid by the employer.

Employer Paid Monthly Premium for family coverage

______________ = X number x 100 = % of Premium Paid by Employer

Total Monthly Premium

Ex: $600/$1,000 = 0.6 x 100 = 60% of the Premium is paid by Employer

100% Employer Paid for Employee

75-99% Employer Paid for Employee

50-74% Employer Paid for Employee

Less than 50% Employer Paid for Employee

Not Employer Paid but Available for Employee

100% Employer Paid for Family

75-99% Employer Paid for Family

50-74% Employer Paid for Family

Less than 50% Employer Paid for Family

Not Employer Paid but Available for Family

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* 23. Check the Employee Benefit options your business provides (Dental)

100% Employer Paid for Employee

Partial Employer Paid for Employee

Not Employer Paid but Available for Employee

100% Employer Paid for Family

Partial Employer Paid for Family

Not Employer Paid but Available for Family

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* 24. Check the Employee Benefit options your business provides (Vision)

100% Employer Paid for Employee

Partial Employer Paid for Employee

Not Employer Paid but Available for Employee

100% Employer Paid for Family

Partial Employer Paid for Family

Not Employer Paid but Available for Family

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* 25. Check the Employee Benefit options your business provides (Disability)

100% Employer Paid for Employee

Partial Employer Paid for Employee

Not Employer Paid but Available for Employee

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* 26. Check the Employee Benefit options your business provides (Life)

100% Employer Paid for Employee

Partial Employer Paid for Employee

Not Employer Paid but Available for Employee

100% Employer Paid for Family

Partial Employer Paid for Family

Not Employer Paid but Available for Family

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* 27. Check the Employee Benefit options your business provides (Voluntary Insurance Programs)

Employee Life

Dependent Life

Disability Supplemental

Long Term Care

Supplemental Products (Accident, Cancer, Sickness, etc.)

Pet Insurance

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* 28. Check the Employee Benefit options your business provides (Additional Benefits)

Retirement Plan or 401K

Phased Retirement

Preretirement Planning Services

Pretax (Section 125) Account to assist with healthcare costs

Paid Time Off for Volunteer Work

Unpaid Time Off for Volunteer Work

Adoption Assistance Program

Employee Tuition Assistance Benefit

College Tuition Assistance for Children

Employee Assistance Program (EAP)

Legal/Identity Theft Protection

Employee Wellness Program

Wellness Tips Provided Quarterly

Annual Health Risk Assessment

Seasonal Flu Vaccination

Smoking Cessation Program

Weight Loss Program

Life Coaching

Nutritional Counseling

Onsite Quiet Room

Offsite Fitness Center Membership

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* 29. Check the Other Family Positive Benefits your business provides

Opportunity for Skill Development or Improvement

Job Cross-Training

Career Counseling

Formal Mentoring Program

Payment of Certification/Recertification Fees

Professional Memberships

Encourage Personalization of Workplace

Casual Dress Days

Personal Errand Services

Holiday Fund

Credit Union Membership

Auto Deposit of Paycheck

Extracurricular Activities Fund for Children

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* 30. Check the Parental/Family Resources & Accommodations your business provides, along with additional training provided.

Employer-Sponsored Child Care

Backup Child Care Services

Sick Child Care

Children at Work Options

Child Care Resource & Referral

Employer offers on-site childcare at a 3-star rating or higher (per YoungStar’s childcare rating system)

Employer pays 50% or more of family expenses for childcare at a 3-star rating or higher (per YoungStar’s childcare rating system)

Employer pays 25%-49% of family expenses for childcare at a 3-star rating or higher (per YoungStar’s childcare rating system)

Employer contributes to a Flexible Spending Account (FSA) for childcare

Employer offers a Flexible Spending Account (FSA) for childcare (employer does not contribute)

Dedicated Nursing/Lactation Facility

Diaper Changing Station in Male and Female Restrooms

Family Restroom

Elder Care Resources

Organized Family Events

Employer offers parenting education/support for employees

Employer offers parenting topic speakers at employee meetings on at least annually

Employer offers early childhood literature for employees

Employer offers early childhood speakers at employee meetings on at least annually

Provide information on the importance and need for understanding the value of diversity, equity, and inclusion. Provide a resource document with helpful ways to discuss race with your children and a list of children’s books to support these conversations. The Family Positive Workplace Council can help you find these resources if needed.

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* 31. Other Family Positive Workplace Practices that your business provides:

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* 32. What made you and your organization want to initiate and become certified in Family Positive Policies?

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* 33. Have Family Positive Policies improved staff morale, given employees' flexibility, or increased the value of your staff benefits package? If so, please explain.

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* 34. Please provide any testimonials you have received from employees since implementing Family Positive Policies. If possible, provide two or three employee comments.

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* 35. If available, please provide a copy of your organizations Family Positive Policies. This will aide in the certification process.

PDF, DOC, DOCX, JPG, JPEG file types only.

Choose File

To receive points for early childhood literature for employees, employers may bring early childhood information to the attention of their employees through lunch & learn classes, speakers, articles, books, videos, and other resources. Examples include discussing and distributing information at company meetings, including articles in the company newsletter or other communication media. These resources may be obtained from a local family resource center or other family-oriented agencies or organizations. Please visit http://www.ok25by25.org to find more detailed information and resources.

In addition to the above criteria, employers might consider the following policies and practices that would align well with the Potts Family Foundation's OK25by25 initiative, supporting FAMILIES WITH CHILDREN, PRE-BIRTH TO FIVE. (www.pottsfamilyfoundation.org)

1. Support local backpack programs and other back-to-school projects
2. Maintain an internal food pantry program for employees working at or below the poverty line.
3. Offer wages that start at or above $12.07 an hour.
4. Have a confidential employee assistance program that will assist employees in registering for additional Food Assistance such as SNAP, or reduced school lunch programs.
5. Check into arranging a tuition discount program with a local college or university.
6. Sponsor and encourage employees to attend school reading nights, math nights, science, and
after-school programs.
7. Offer free flu shots to the family regardless they are on your health plan or not.
8. Offer pre-natal and post-birth counseling as part of your employee wellness program.
9. Provide information for free or reduced-cost vaccinations for families.

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* 36. Agreement and Signature
By submitting this application, I affirm to the best of my knowledge that the above statements are accurate and complete. I understand if my business is accepted as a Certified Workplace, any false statements, omissions, or other misrepresentations made by me on this application may result in disqualification for the recognition.

Name (Printed)

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* 37. Signature

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* 38. Date

Date / Time

Date

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* 39. The Family Positive Workplace Certification Program will often make presentations, flyers, and handouts to promote the program. These promotional items may include past testimonials and responses from recipients of the Certification. Please indicate below if you will allow the Family Positive Workplace Council to use your testimonials and open-ended responses of this application for promoting the Family Positive Workplace Certification Program.

Yes, I give my permission

No, I do not give my permission

This document may be reviewed and revised on a scheduled basis and as deemed appropriate and necessary with or without notice by the Family Positive Workplace Council.

Please visit http:www.pottsfamilyfoundation.org to find more detailed application information. For questions or more information, please contact Linda Manaugh at lmanaugh@pottsfamilyfoundation.org Thank you!