St. Elizabeth Occupational Health Survey Question Title * 1. What services does your company currently utilize for occupational medicine? (check all that apply) DOT Preplacement Physical NON-DOT Preplacement Physical Drug Testing Hearing Test Respirator Fit Testing Physical Demands Test (JPA) Injury Treatment Vaccinations (Hepatitis, Flu, Tdap) Employee Assistance Program Wellness Question Title * 2. What services from the previous question would you be interested in utilizing? If you want more information on a specific service, provide your contact information and we will reach out to you DOT Preplacement Physical Non-DOT Preplacement Physical Drug Testing Hearing Test Respirator Fit Testing Physical Demands Test (JPA) Injury Treatment Vaccinations (Hepatitis, Flu, Tdap) Employee Assistance Program Wellness Contact Information Question Title * 3. Who do you currently use for occupational medicine services? Local Physician St Elizabeth Business Health Urgent Care Emergency Room Other (please specify) Question Title * 4. In your opinion, what is an appropriate driving distance for your employees to drive for occupational medicine? 15-20 minutes 20-30 minutes 30+ minutes Question Title * 5. Roughly how many workers compensation injuries do you experience annually? 0-10 11-20 21+ Question Title * 6. In your opinion, what is the most important factor during the decision-making process for what provider to use for occupational medicine? Cost Distance/Convenience Healthcare entity’s reputation Services tailored towards company specifications Hours of operation Board Certified Occupational Medicine Physicians Question Title * 7. How many employees do you currently employ both full and part-time? Under 25 25-50 50-75 75-100 100-150 150 – 250 250-500 500+ Done