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2016 HLI Checklist Tool

1. Checklist Tool

Question Title

* 1. What public health laboratory are you from? Please include your state and contact information for follow-up.

Name:

Laboratory:

State:

Email Address:

Phone Number:

Question Title

* 2. Clinical: Personal Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory participate in a Wellness Program including courses, a newsletter, or a website?	Does your agency/laboratory participate in a Wellness Program including courses, a newsletter, or a website? Implemented (2 pts)	Does your agency/laboratory participate in a Wellness Program including courses, a newsletter, or a website? Partially Implemented (1 pt)	Does your agency/laboratory participate in a Wellness Program including courses, a newsletter, or a website? No (0 pts)

Question Title

* 3. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have a Wellness Coordinator or other personnel responsible for the wellness program?	Does your agency/laboratory have a Wellness Coordinator or other personnel responsible for the wellness program? Implemented (2 pts)	Does your agency/laboratory have a Wellness Coordinator or other personnel responsible for the wellness program? Partially Implemented (1 pt)	Does your agency/laboratory have a Wellness Coordinator or other personnel responsible for the wellness program? No (0 pts)
Does your laboratory have a way to represent employees in the wellness program?	Does your laboratory have a way to represent employees in the wellness program? Implemented (2 pts)	Does your laboratory have a way to represent employees in the wellness program? Partially Implemented (1 pt)	Does your laboratory have a way to represent employees in the wellness program? No (0 pts)

Question Title

* 4. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have a program (either through the wellness program or other) that rewards employees for good health/healthy behaviors?	Does your agency/laboratory have a program (either through the wellness program or other) that rewards employees for good health/healthy behaviors? Implemented (2 pts)	Does your agency/laboratory have a program (either through the wellness program or other) that rewards employees for good health/healthy behaviors? Partially Implemented (1 pt)	Does your agency/laboratory have a program (either through the wellness program or other) that rewards employees for good health/healthy behaviors? No (0 pts)

Question Title

* 5. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory display monthly posters or other publication campaigns on different health or safety topics?	Does your agency/laboratory display monthly posters or other publication campaigns on different health or safety topics? Implemented (2 pts)	Does your agency/laboratory display monthly posters or other publication campaigns on different health or safety topics? Partially Implemented (1 pt)	Does your agency/laboratory display monthly posters or other publication campaigns on different health or safety topics? No (0 pts)

Question Title

* 6. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have workplace challenges/competitions to increase nutrition and fitness?	Does your agency/laboratory have workplace challenges/competitions to increase nutrition and fitness? Implemented (2 pts)	Does your agency/laboratory have workplace challenges/competitions to increase nutrition and fitness? Partially Implemented (1 pt)	Does your agency/laboratory have workplace challenges/competitions to increase nutrition and fitness? No (0 pts)

Question Title

* 7. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory actively integrate its health promotion efforts with those of the community in which it resides?	Does your agency/laboratory actively integrate its health promotion efforts with those of the community in which it resides? Implemented (2 pts)	Does your agency/laboratory actively integrate its health promotion efforts with those of the community in which it resides? Partially Implemented (1 pt)	Does your agency/laboratory actively integrate its health promotion efforts with those of the community in which it resides? No (0 pts)

Question Title

* 8. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have a health promotion program for nutrition including education about nutrition and food labels?	Does your agency/laboratory have a health promotion program for nutrition including education about nutrition and food labels? Implemented (2 pts)	Does your agency/laboratory have a health promotion program for nutrition including education about nutrition and food labels? Partially Implemented (1 pt)	Does your agency/laboratory have a health promotion program for nutrition including education about nutrition and food labels? No (0 pts)

Question Title

* 9. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have a health promotion program for weight loss?	Does your agency/laboratory have a health promotion program for weight loss? Implemented (2 pts)	Does your agency/laboratory have a health promotion program for weight loss? Partially Implemented (1 pt)	Does your agency/laboratory have a health promotion program for weight loss? No (0 pts)

Question Title

* 10. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have a health promotion program for exercise including flextime for exercise, demonstrations, onsite gym or other offers?	Does your agency/laboratory have a health promotion program for exercise including flextime for exercise, demonstrations, onsite gym or other offers? Implemented (2 pts)	Does your agency/laboratory have a health promotion program for exercise including flextime for exercise, demonstrations, onsite gym or other offers? Partially Implemented (1 pt)	Does your agency/laboratory have a health promotion program for exercise including flextime for exercise, demonstrations, onsite gym or other offers? No (0 pts)

Question Title

* 11. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have a health promotion program for health screenings/assessments? (For example, regular blood pressure monitoring, cholesterol screenings on site, cancer screenings offered on site or at a discount to visit doctor's office.)	Does your agency/laboratory have a health promotion program for health screenings/assessments? (For example, regular blood pressure monitoring, cholesterol screenings on site, cancer screenings offered on site or at a discount to visit doctor's office.) Implemented (2 pts)	Does your agency/laboratory have a health promotion program for health screenings/assessments? (For example, regular blood pressure monitoring, cholesterol screenings on site, cancer screenings offered on site or at a discount to visit doctor's office.) Partially Implemented (1 pt)	Does your agency/laboratory have a health promotion program for health screenings/assessments? (For example, regular blood pressure monitoring, cholesterol screenings on site, cancer screenings offered on site or at a discount to visit doctor's office.) No (0 pts)

Question Title

* 12. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have a health promotion program for yearly flu shot immunizations for employees?	Does your agency/laboratory have a health promotion program for yearly flu shot immunizations for employees? Implemented (2 pts)	Does your agency/laboratory have a health promotion program for yearly flu shot immunizations for employees? Partially Implemented (1 pt)	Does your agency/laboratory have a health promotion program for yearly flu shot immunizations for employees? No (0 pts)
Is the immunization program funded by your laboratory/agency?	Is the immunization program funded by your laboratory/agency? Implemented (2 pts)	Is the immunization program funded by your laboratory/agency? Partially Implemented (1 pt)	Is the immunization program funded by your laboratory/agency? No (0 pts)

Question Title

* 13. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have a health promotion program for alternative medicine (for example: chiropractic, accupuntucture, massage therapy)?	Does your agency/laboratory have a health promotion program for alternative medicine (for example: chiropractic, accupuntucture, massage therapy)? Implemented (2 pts)	Does your agency/laboratory have a health promotion program for alternative medicine (for example: chiropractic, accupuntucture, massage therapy)? Partially Implemented (1 pt)	Does your agency/laboratory have a health promotion program for alternative medicine (for example: chiropractic, accupuntucture, massage therapy)? No (0 pts)

Question Title

* 14. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have a health promotion program for ergonomics?	Does your agency/laboratory have a health promotion program for ergonomics? Implemented (2 pts)	Does your agency/laboratory have a health promotion program for ergonomics? Partially Implemented (1 pt)	Does your agency/laboratory have a health promotion program for ergonomics? No (0 pts)

Question Title

* 15. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have a morning stretch program?	Does your agency/laboratory have a morning stretch program? Implemented (2 pts)	Does your agency/laboratory have a morning stretch program? Partially Implemented (1 pt)	Does your agency/laboratory have a morning stretch program? No (0 pts)

Question Title

* 16. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory have a health promotion program for stress reduction (some examples include seminars on stress management, encourage relaxation techniques.)?	Does your agency/laboratory have a health promotion program for stress reduction (some examples include seminars on stress management, encourage relaxation techniques.)? Implemented (2 pts)	Does your agency/laboratory have a health promotion program for stress reduction (some examples include seminars on stress management, encourage relaxation techniques.)? Partially Implemented (1 pt)	Does your agency/laboratory have a health promotion program for stress reduction (some examples include seminars on stress management, encourage relaxation techniques.)? No (0 pts)

Question Title

* 17. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory offer support programs for smoking cessation or other chemical dependencies?	Does your agency/laboratory offer support programs for smoking cessation or other chemical dependencies? Implemented (2 pts)	Does your agency/laboratory offer support programs for smoking cessation or other chemical dependencies? Partially Implemented (1 pt)	Does your agency/laboratory offer support programs for smoking cessation or other chemical dependencies? No (0 pts)

Question Title

* 18. Clinical: Public Health Promotion

	Implemented (2 pts)	Partially Implemented (1 pt)	No (0 pts)
Does your agency/laboratory offer counselor services for emotional wellbeing?	Does your agency/laboratory offer counselor services for emotional wellbeing? Implemented (2 pts)	Does your agency/laboratory offer counselor services for emotional wellbeing? Partially Implemented (1 pt)	Does your agency/laboratory offer counselor services for emotional wellbeing? No (0 pts)