Thank you for your interest in the Public Health Agency’s 28 Day Workplace Stop Smoking Challenge, and for taking the time to complete this registration.

Remember, if smokers stop smoking for 28 days or more they are five times more likely to stop for good.

We would like to find out what type of businesses’ take part in the 28 Day Workplace Stop Smoking Challenge and would be grateful if you would complete the following registration form. Your responses are strictly confidential. No business will be identified in any reports produced.

Remember, more information in relation to the 28 Day Workplace Challenge is available at

(Please note those questions marked with an asterisk need to be answered)