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Growing Healthy Worksites Application

Growing Healthy Worksites Application

Applications for the Growing Healthy Worksites project will be reviewed by the ArCOP board. Positions and funding are limited. 

The following application will be used to gather information on employers interested in participating in the Growing Healthy Worksites project: in using evidence-based tools to implement Policy, System, and Environmental changes at their worksites to create sustainable changes to benefit their employees' health. 

Questions in the application have point values. The point system will be utilized by the ArCOP board to give your organization a preliminary score. Please answer each question honestly as it pertains to your worksite.

Regional training dates TBA. 

Growing Healthy Worksites Application

The following demographic information is required for application completion. However, please note that ArCOP does not collect and maintain information on the following reported employee characteristics: sex, age group, average age, racial/ethnic group, and education level.
 

Employee Characteristics
Number of Employees
Employee Sex
Employee Age Group
Employee Racial/Ethnic Group
Employee Work Status
Employee Job type
Employee Education level
Your Organization’s Business Type
Your Organization’s Industry Type:
Health insurance coverage provided to employees?
Elements of worksite health promotion programs offered at your organization: (check all that apply)
CDC Worksite Health ScoreCard: Organizational Supports

For Organizational Supports questions 1-18, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Organizational Supports score: 33 points)

1. 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).
2. 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.
3. During the last 12 months, did your worksite demonstrate organizational commitment and support of 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.
4. 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.
5. 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.
6. 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.
7. 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?
8. 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).
9. 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.
10. 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.
11. 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.
12. During the last 12 months, did your worksite have an annual budget or receive dedicated funding for health promotion programs?
13. During the last 12 months, did your worksite set annual organizational objectives for health promotion?
14. 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.
15. 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.
16. During the last 12 months, did your worksite make any health promotion programs available to family members?
17. 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.
18. 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.
CDC Worksite Health ScoreCard: Tobacco Control

For Tobacco Control questions 19-28, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Tobacco Control score: 19)

19. 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, countywide, or citywide policy banning tobacco use in the workplace.
20. 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.
21. During the last 12 months, did your worksite display signs (including ‘no smoking’ signs) with information about your tobacco-use policy?
22. 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.
23. 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).
24. 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.
25. 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.
26. During the last 12 months, did your worksite inform employees about health insurance coverage or programs that include tobacco cessation medication and counseling?
27. 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, or other benefits for non-smokers and tobacco users who are actively trying to quit.
28. During the last 12 months, did your worksite 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.
CDC Worksite Health ScoreCard: Nutrition

For Nutrition questions 29-41, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Nurition score: 21 points)

29. 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.
30. 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.
31. 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.
32. 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.)
33. 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?
34. 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.
35. 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?
36. 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.
37. 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 and/or kitchen.
38. 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?
39. During the last 12 months, did your worksite provide brochures, videos, posters, pamphlets, newsletters, or other written or online 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.
40. 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 online; 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.
41. 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 online; 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.
CDC Worksite Health ScoreCard: Lactation Support

For Lactation Support questions 42-47, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Lactation Support score: 15 points)

42. During the last 12 months, did your worksite have a written policy on breastfeeding for employees?
Answer “yes” if the policy is included as a component of other employee policies or is a separate policy related to breastfeeding.
43. 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?
44. During the last 12 months, did your worksite provide access to a breast pump at the worksite?
45. During the last 12 months, did your worksite provide flexible paid or unpaid break times to allow mothers to pump breast milk?
46. 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 online; onsite or offsite; in group or individual settings; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners.
47. During the last 12 months, did your worksite offer paid maternity leave, separate from any accrued sick leave, annual leave, or vacation time?
CDC Worksite Health ScoreCard: Physical Activity

For Physical Activity questions 48-56, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Physical Activity score: 24 points)

48. During the last 12 months, did your worksite provide an exercise facility on-site?
49. During the last 12 months, did your worksite subsidize or discount the cost of on-site or offsite exercise facilities?
50. During the last 12 months, did your worksite provide 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.
51. 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.
52. 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 or stretching programs, group exercise, or weight training.
53. During the last 12 months, did your worksite provide brochures, videos, posters, pamphlets, newsletters, or other written or online 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
54. 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 online; 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.
55. 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?
56. 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 online; 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.
CDC Worksite Health ScoreCard: Weight Management

For Weight Management questions 57-61, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Weight Management score: 12 points)

57. 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 self-report) followed by directed feedback and clinical referral when appropriate?
58. During the last 12 months, did your worksite provide brochures, videos, posters, pamphlets, newsletters, or other written or online 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.
59. 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 online; 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.
60. 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 online; 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.
61. 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 online; 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.
CDC Worksite Health ScoreCard: Stress Management

For Stress Management questions 62-67, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Stress Management score: 14 points)

62. During the last 12 months, did your worksite provide dedicated space that is quiet where employees can engage in relaxation activities, such as deep breathing exercises?
63. During the last 12 months, did your worksite sponsor or organize social events throughout the year?
Answer “yes” if, for example, your worksite sponsors or organizes team building events, company picnics, holiday parties, or employee sports teams.
64. During the last 12 months, did your worksite provide stress management programs?
Answer “yes” if these programs address stress management as a single health topic or if stress management is included with other health topics. Answer “yes” if these programs are provided in-person or online; 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.
65. During the last 12 months, did your worksite provide work-life balance/ life-skills programs?
Answer “yes” if, for example, your worksite provides elder care, child care, referrals, tuition reimbursement, or other programs that are offered through vendors, on-site staff, or employee assistance programs.
66. During the last 12 months, did your worksite provide training for managers on identifying and reducing workplace stress-related issues?
Answer “yes” if, for example, your worksite provides training on performance reviews, communication, personnel management, assertiveness, time management, or conflict resolution.
67. During the last 12 months, did your worksite provide opportunities for employee participation in organizational decisions regarding workplace issues that affect job stress?
Answer “yes” if, for example, your worksite provides opportunities for employees to participate in decisions about work processes and environment, work schedules, participative problem-solving, and management of work demands.
CDC Worksite Health ScoreCard: Depression

For Depression questions 68-74, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Depression score: 18 points)

68. During the last 12 months, did your worksite provide free or subsidized clinical screening for depression (beyond self-report) followed-by directed feedback and clinical referral when appropriate?
Answer “yes” if these services are provided directly through your organization or indirectly through a health insurance plan.
69. During the last 12 months, did your worksite provide access to online or paper self-assessment depression screening tools?
70. During the last 12 months, did your worksite provide brochures, videos, posters, pamphlets, newsletters, or other written or online information that address depression?
Answer “yes” if these health promotion materials address depression as a single health topic or if depression is included with other health topics.
71. During the last 12 months, did your worksite provide a series of educational seminars, workshops, or classes on preventing and treating depression?
Answer “yes” if these sessions address depression as a single health topic or if depression is included with other health topics. These sessions can be provided in-person or online; 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.
72. During the last 12 months, did your worksite provide one-on-one or group lifestyle counseling for employees with depression?
Answer “yes” if these programs are provided in-person or online; onsite or off-site; in group or individual settings; through vendors, onsite staff, health insurance plans and programs, community groups, or other practitioners.
73. During the last 12 months, did your worksite provide training for managers on depression in the workplace?
Answer “yes” if, for example, your worksite provides managers with training on how to recognize depression, productivity or safety issues, and company or community resources for managing depression.
74. During the last 12 months, did your worksite provide health insurance coverage with no or low out-ofpocket costs for depression medications and mental health counseling?
CDC Worksite Health ScoreCard: High Blood Pressure

For High Blood Pressure questions 75-81, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum High Blood Pressure score: 17 points)

75. During the last 12 months, did your worksite provide free or subsidized blood pressure screening (beyond self-report) followed by directed feedback and clinical referral when appropriate?
76. During the last 12 months, did your worksite provide brochures, videos, posters, pamphlets, newsletters, or other written or online information that address the risks of high blood pressure?
Answer “yes” if these health promotion materials address the risks of high blood pressure as a single health topic or if the risks of high blood pressure are included with other health topics.
77. During the last 12 months, did your worksite provide a series of educational seminars, workshops, or classes on preventing and controlling high blood pressure?
Answer “yes” if these sessions address preventing or controlling high blood pressure as a single health topic or if preventing and controlling high blood pressure are included with other health topics. These sessions can be provided in-person or online; on-site or offsite; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.
78. During the last 12 months, did your worksite provide one-on-one or group lifestyle counseling and follow-up monitoring for employees with high blood pressure or prehypertension?
Answer “yes” if these programs are provided in-person or online; 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.
79. During the last 12 months, did your worksite provide free or subsidized self-management programs for blood pressure control and prevention?
Answer “yes” if these programs are provided in-person or online; 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.
80. During the last 12 months, did your worksite make blood pressure monitoring devices available with instructions for employees to conduct their own self assessments?
81. During the last 12 months, did your worksite provide health insurance coverage with no or low out-of-pocket costs for blood pressure control medications?
CDC Worksite Health ScoreCard: High Cholesterol

For High Cholesterol questions 82-87, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum High Cholesterol score: 15 points)

82. During the last 12 months, did your worksite provide free or subsidized cholesterol screening (beyond selfreport) followed by directed feedback and clinical referral when appropriate?
83. During the last 12 months, did your worksite provide brochures, videos, posters, pamphlets, newsletters, or other written or online information that address the risks of high cholesterol?
Answer “yes” if these health promotion materials address the risks of high cholesterol as a single health topic or if the risks of high cholesterol are included with other health topics.
84. During the last 12 months, did your worksite provide a series of educational seminars, workshops, or classes on preventing and controlling high cholesterol?
Answer “yes” if these sessions address preventing andcontrolling high cholesterol as a single health topic or if preventing and controlling high cholesterol are included with other health topics. These sessions can be provided in-person or online; 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.
85. During the last 12 months, did your worksite provide one-on-one or group lifestyle counseling and follow-up monitoring for employees who have high cholesterol?
Answer “yes” if these programs are provided in-person or online; 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.
86. During the last 12 months, did your worksite provide free or subsidized self-management programs for cholesterol or lipid control?
Answer “yes” if these programs are provided in-person or online; onsite or off-site; in group or individual settings; through vendors, onsite staff, health insurance plans and programs, community groups, or other practitioners.
87. During the last 12 months, did your worksite provide health insurance coverage no or low out-of-pocket costs for cholesterol or lipid control medications?
CDC Worksite Health ScoreCard: Diabetes

For Diabetes questions 88-93, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Diabetes score: 15 points)

88. During the last 12 months, did your worksite provide free or subsidized pre-diabetes and diabetes risk factor assessment (beyond self-report) and feedback, followed by blood glucose screening and/or clinical referral when appropriate?
89. During the last 12 months, did your worksite provide brochures, videos, posters, pamphlets, newsletters, or other written or online information that address the risks of diabetes?
Answer “yes” if these health promotion materials address the risks of diabetes as a single health topic or if the risks of diabetes are included with other health topics.
90. During the last 12 months, did your worksite provide a series of educational seminars, workshops, or classes on preventing and controlling diabetes?
Answer “yes” if these sessions address preventing and controlling diabetes as a single health topic or if preventing and controlling diabetes are included with other health topics. These sessions can be provided in-person or online; 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.
91. During the last 12 months, did your worksite provide one-on-one or group lifestyle counseling and follow-up monitoring for employees who have abnormal blood glucose levels (pre-diabetes or diabetes)?
Answer “yes” if these programs are provided in-person or online; 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.
92. During the last 12 months, did your worksite provide free or subsidized self-management programs for diabetes control?
Answer “yes” if these programs are provided in-person or online; 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.
93. During the last 12 months, did your worksite provide health insurance coverage with no or low out-ofpocket costs for diabetes medications and supplies for diabetes management (glucose test strips, needles, monitoring kits)?
CDC Worksite Health ScoreCard: Signs and Symptoms of Heart Attack and Stroke

For Signs and Symptoms of Heart Attack and Stroke questions 94-97, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Signs and Symptoms of Heart Attack and Stroke score: 4 points)

94. During the last 12 months, did your worksite have posters or flyers in the common areas of your worksite (such as bulletin boards, kiosks, break rooms) that identify the signs and symptoms of a heart attack and also convey that heart attacks are to be treated as emergencies?
95. During the last 12 months, did your worksite have posters or flyers in the common areas of your worksite (such as bulletin boards, kiosks, break rooms) that identify the signs and symptoms of a stroke and also convey that strokes are to be treated as emergencies?
96. During the last 12 months, did your worksite provide any other information on the signs and symptoms of heart attack through emails, newsletters, management communications, Web sites, seminars or classes?
97. During the last 12 months, did your worksite provide any other information on the signs and symptoms of stroke through e-mails, newsletters, management communications, Web sites, seminars or classes?
CDC Worksite Health ScoreCard: Emergency Response to Heart Attack and Stroke

For Emergency Response to Heart Attack and Stroke questions 98-106, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Emergency Response to Heart Attack and Stroke score: 17 points)

98. During the last 12 months, did your worksite have an emergency response plan that addresses acute heart attack and stroke events?
99. During the last 12 months, did your worksite have an emergency response team for medical emergencies?
100. During the last 12 months, did your worksite offer access to a nationally-recognized training course on Cardiopulmonary Resuscitation (CPR) that includes training on Automated External Defibrillator (AED) usage?
101. During the last 12 months, did your worksite have a policy that requires an adequate number of employees per floor, work unit, or shift, in accordance with pertinent state and federal laws, to be certified in CPR/AED?
102. During the last 12 months, did your worksite have one or more functioning AEDs in place?
103. During the last 12 months, did your worksite have an adequate number of AED units such that a person can be reached within 3–5 minutes of collapse?
104. During the last 12 months, did your worksite identify the location of AEDS with posters, signs, markers, or other forms of communication other than on the AED itself?
105. During the last 12 months, did your worksite perform routine maintenance or testing on all AEDs?
106. During the last 12 months, did your worksite provide information to your local community Emergency Medical Service providers so they are aware that your worksite has an AED in place for an emergency response?
CDC Worksite Health ScoreCard: Occupational Health and Safety

For Occupational Health and Safety questions 107-116, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Occupational Health and Safety score: 22 points)

107. During the last 12 months, did your worksite include improving or maintaining job health and safety in the business objectives or organizational mission statement?
Answer “yes” if any written vision, planning, or guideline documents include language about improving or maintaining worker health and safety.
108. During the last 12 months, did your worksite have a written injury and/or illness prevention program?
Answer “yes” if there is a written policy, whether or not it is posted.
109. During the last 12 months, did your worksite employ or contract for an occupational health and safety professional?
Answer “yes” if anyone is employed or contracted whose job includes improving health safety: example include occupational nurse, safety manager, environmental health manager, ergonomist, an insurance safety specialist who visits regularly.
110. During the last 12 months, did your worksite encourage reporting of injuries and near misses?
Answer “yes” if there is written and/or verbal encouragement to report injuries, illnesses, or near misses.
111. During the last 12 months, did your worksite provide opportunities for employee input on hazards and solutions?
Answer “yes” if, for example, there were all-hands meetings, tool box meetings, surveys, or focus groups for discovering and solving job health and/or safety issues.
112. During the last 12 months, did your worksite have a program to investigate the causes of injuries or illnesses?
Answer “yes” if, for example, there were all-hands meetings, tool box meetings, surveys, or focus groups for discovering and solving job health and/or safety issues.
113. During the last 12 months, did your worksite provide informational materials about health and safety at work to employees in most departments?
Answer “yes” if, for example, there are health and safety newsletters, fact sheets, posters, LED displays, emails, letters, broadcast messages, or other communications provided to employees.
114. During the last 12 months, did your worksite provide all new workers formal, comprehensive training on how to avoid accidents or injury on the job?
115. During the last 12 months, did your worksite coordinate programs for occupational health and safety with program for health promotion and wellness?
Answer “yes” if, for example a new safety initiative also includes a wellness component such as attention to diet, physical activity, smoking, etc.).
116a. Have the following policies or benefits for employees been in place?: Paid time off (PTO) for days or hours due to illness of employees or dependents (full-time, non-exempt employees).
[Note: non-exempt employees are those who are eligible to receive overtime pay if they work more than 40 hours in a week. Typically they are hourly workers.]
116b. Have the following policies or benefits for employees been in place?: Paid vacation time or personal days or hours to full-time, nonexempt employees).
CDC Worksite Health ScoreCard: Vaccine-Preventable Diseases (VPD)

For Vaccine-Preventable Diseases questions 117-122, please select "Yes" or "No" in response to your worksite during the last 12 months.

(Maximum Vaccine-Preventable Diseases score: 18 points)

117. During the last 12 months, did your worksite provide health insurance coverage with no or low out-of-pocket costs for influenza (flu) vaccination?
118. During the last 12 months, did your worksite provide health insurance coverage with no or low out-ofpocket costs for vaccinations other than influenza (flu) (e.g., pneumococcal or Tdap vaccines)?
119. During the last 12 months, did your worksite conduct influenza (flu) vaccinations at your worksite?
Answer “yes” if these offerings happen one or more times a year; are set up as either a temporary vaccine clinic run by an outside organization, internal occupational health staff or other arrangement.
120. During the last 12 months, did your worksite provide influenza (flu) vaccinations at your worksite with no or low out-of-pocket costs to employees?
Answer “yes” if these offerings happen one or more times a year; are set up as either a temporary vaccine clinic run by an outside organization, internal occupational health staff or other arrangement.
121. During the last 12 months, did your worksite provide vaccinations other than seasonal influenza (e.g. pneumococcal or Tdap) at your worksite with no or low out-of-pocket costs to employees?
Answer “yes” if these offerings happen one or more times a year; are set up as either a temporary vaccine clinic run by an outside organization, internal occupational health staff or other arrangement.
122. During the last 12 months, did your worksite promote influenza (flu) vaccinations through brochures, videos, posters, pamphlets, newsletters or other written or online information that address the benefits of influenza vaccinations?
Answer “yes” if these health promotion materials address the risks and benefits of influenza vaccination as a single health topic or if the benefits of influenza vaccinations are included with other health topics.
CDC Worksite Health ScoreCard: Community Resources

For Community Resources questions 123-125, please select "Yes" or "No" in response to your worksite during the last 12 months.

123a. During the last 12 months, did your worksite provide employees with health related information, programs, or resources from a State/local public health agency?
123b. During the last 12 months, did your worksite provide employees with health related information, programs, or resources from a health insurance plan?
123c. During the last 12 months, did your worksite provide employees with health related information, programs, or resources from a health management program and/or wellness program provider/vendor?
123d. During the last 12 months, did your worksite provide employees with health related information, programs, or resources from a workers compensation provider?
123e. During the last 12 months, did your worksite provide employees with health related information, programs, or resources from health-related organizations (such as the American Heart Association, American Cancer Society, etc.)?
123f. During the last 12 months, did your worksite provide employees with health related information, programs, or resources from a health insurance broker?
123g. During the last 12 months, did your worksite provide employees with health related information, programs, or resources from a hospital?
123h. During the last 12 months, did your worksite provide employees with health related information, programs, or resources from the YMCA?
123i. During the last 12 months, did your worksite provide employees with health related information, programs, or resources from a Community Organization or Business Group (Wellness Council, Chamber of Commerce or other business group)?
For example, if you work with an organization not listed above such as an Employee Assistance Program, Food Services, etc. to provide health information, programs, or resources to employees.
124a. During the last 12 months, did your worksite receive consultation, guidance, advise, training, and/or direction from a state/local public health agency related to the design and delivery of a worksite wellness program?
124b. During the last 12 months, did your worksite receive consultation, guidance, advise, training, and/or direction from a health insurance plan related to the design and delivery of a worksite wellness program?
124c. During the last 12 months, did your worksite receive consultation, guidance, advise, training, and/or direction from a health management program and/or wellness program provider/vendor related to the design and delivery of a worksite wellness program?
124d. During the last 12 months, did your worksite receive consultation, guidance, advise, training, and/or direction from a workers compensation provider related to the design and delivery of a worksite wellness program?
124e. During the last 12 months, did your worksite receive consultation, guidance, advise, training, and/or direction from Health Related Organizations (such as the American Heart Association, American Cancer Society, etc.) related to the design and delivery of a worksite wellness program?
124f. During the last 12 months, did your worksite receive consultation, guidance, advise, training, and/or direction from a health insurance broker related to the design and delivery of a worksite wellness program?
124g. During the last 12 months, did your worksite receive consultation, guidance, advise, training, and/or direction from a hospital related to the design and delivery of a worksite wellness program?
124h. During the last 12 months, did your worksite receive consultation, guidance, advise, training, and/or direction from the YMCA related to the design and delivery of a worksite wellness program?
124i. During the last 12 months, did your worksite receive consultation, guidance, advise, training, and/or direction from a Community or Business Organization (Wellness Council, Chamber of Commerce or other business group) related to the design and delivery of a worksite wellness program?
For example, if you work with an organization not listed above such as an Employee Assistance Program, Food Services, etc. to provide health information, programs, or resources to employees.
125. In the last 12 months, did your worksite participate in any Community Coalitions focused on health or business and community partnerships?

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