The CDC Worksite Health ScoreCard

An Assessment Tool to Prevent Heart Disease, Stroke, and Related Conditions Worksheet



Organizational Supports

During the past 12 months, did your worksite: Yes No
  1. 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).
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. Use examples of employees role modeling appropriate health behaviors or employee health-related “success stories” in the marketing materials?
  1. 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).
  1. Have an active health promotion committee?
    Answer “yes” if your health promotion committee exists and has been involved in planning and implementing programs.
  1. 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.
  1. 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.
  1. Have an annual budget or receive dedicated funding for health promotion programs?
  1. Set annual organizational objectives for health promotion?
  1. 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.
  1. 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.
  1. Make any health promotion programs available to family members?
  1. Provide flexible work scheduling policies?
    Answer “yes” if, for example, policies allow for flextime schedules and work at home.
  1. 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.

Tobacco Control

During the past 12 months, did your worksite: Yes No
  1. 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.
  1. 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.
  1. Display signs (including ‘no smoking’ signs) with information about your tobacco-use policy?
  1. 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.
  1. 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).
  1. 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.
  1. 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 sta , health insurance plans or programs, community groups, or other practitioners.
  1. Inform employees about health insurance coverage or programs that include tobacco cessation medication and counseling?
  1. 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 bene ts for non-smokers and tobacco users who are actively trying to quit.
  1. Do 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.

Nutrition

During the past 12 months, did your worksite: Yes No
  1. Provide places to purchase food and beverages?
    Answer “yes” if, for example, your worksite provides vending machines, cafeterias, snack bars, or other purchase points. IF NO, PLEASE SKIP TO QUESTION 36.
  1. 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.
  1. 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.
  1. 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 avored 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.)
  1. 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?
  1. 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.
  1. Subsidize or provide discounts on healthier foods and beverages offered in vending machines, cafeterias, snack bars, or other purchase points?
  1. 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.
  1. Provide employees with food preparation and storage facilities?
    Answer “yes” if your worksite provides a microwave oven, sink, refrigerator and/or kitchen.
  1. Over or promote an on-site or nearby farmers’ market where fresh fruits and vegetables are sold?
  1. 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 bene ts of healthy eating as a single health topic or if the benefits of healthy eating are included with other health topics.
  1. Provide a series of educational seminars, workshops, or classes on nutrition?
    Annswer “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.
  1. 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.

Lactation Support

During the past 12 months, did your worksite: Yes No
  1. 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.
  1. Provide a private space (other than a restroom) that may be used by an employee to express breast milk?
  1. Provide access to a breast pump at the worksite?
  1. Provide flexible paid or unpaid break times to allow mothers to pump breast milk?
  1. 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.
  1. Over paid maternity leave, separate from any accrued sick leave, annual leave, or vacation time?

Physical Activity

During the past 12 months, did your worksite: Yes No
  1. Provide an exercise facility on-site?
  1. Subsidize or discount the cost of on-site or o site exercise facilities?
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.

Weight Management

During the past 12 months, did your worksite: Yes No
  1. 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?
  1. 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.
  1. 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.
  1. 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.
  1. 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.

Stress Management

During the past 12 months, did your worksite: Yes No
  1. Provide dedicated space that is quiet where employees can engage in relaxation activities, such as deep breathing exercises?
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.

Depression

During the past 12 months, did your worksite: Yes No
  1. 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.
  1. Provide access to online or paper self-assessment depression screening tools?
  1. 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.
  1. 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.
  1. Provide one-on-one or group lifestyle counseling for employees with depression?
    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.
  1. 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.
  1. Provide health insurance coverage with no or low out-of-pocket costs for depression medications and mental health counseling?

High Blood Pressure

During the past 12 months, did your worksite: Yes No
  1. Provide free or subsidized blood pressure screening (beyond self-report) followed by directed feedback and clinical referral when appropriate?
  1. 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.
  1. 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 off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.
  1. Provide one-on-one or group lifestyle counseling and follow-up monitoring for employees with high blood pressure or pre- hypertension?
    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.
  1. 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.
  1. Make blood pressure monitoring devices available with instructions for employees to conduct their own self assessments?
  1. Provide health insurance coverage with no or low out-of-pocket costs for blood pressure control medications?

High Cholesterol

During the past 12 months, did your worksite: Yes No
  1. Provide free or subsidized cholesterol screening (beyond self- report) followed by directed feedback and clinical referral when appropriate?
  1. 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.
  1. Provide a series of educational seminars, workshops, or classes on preventing and controlling high cholesterol?
    Answer “yes” if these sessions address preventing and controlling 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.
  1. 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.
  1. Provide free or subsidized self-management programs for cholesterol or lipid 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 and programs, community groups, or other practitioners.
  1. Provide health insurance coverage no or low out-of-pocket costs for cholesterol or lipid control medications?

Diabetes

During the past 12 months, did your worksite: Yes No
  1. Provide free or subsidized cholesterol screening (beyond self-report) followed by directed feedback and clinical referral when appropriate?
  1. 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.
  1. Provide a series of educational seminars, workshops, or classes on preventing and controlling high cholesterol?
    Answer “yes” if these sessions address preventing and controlling 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.
  1. 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.
  1. Provide free or subsidized self-management programs for cholesterol or lipid 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 and programs, community groups, or other practitioners.
  1. Provide health insurance coverage no or low out-of-pocket costs for cholesterol or lipid control medications?

Signs and Symptoms of Heart Attack and Stroke

During the past 12 months, did your worksite: Yes No
  1. 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?
  1. 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?
  1. Provide any other information on the signs and symptoms of heart attack through emails, newsletters, management communications, Web sites, seminars or classes?
  1. Provide any other information on the signs and symptoms of stroke through e-mails, newsletters, management communications, Web sites, seminars or classes?

Emergency Response to Heart Attack and Stroke

During the past 12 months, did your worksite: Yes No
  1. Have an emergency response plan that addresses acute heart attack and stroke events?
  1. Have an emergency response team for medical emergencies?
  1. Offer access to a nationally-recognized training course on Cardiopulmonary Resuscitation (CPR) that includes training on Automated External Defibrillator (AED) usage?
  1. 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?
  1. Have one or more functioning AEDs in place?
    IF NO, PLEASE SKIP TO QUESTION 107.
  1. Have an adequate number of AED units such that a person can be reached within 3–5 minutes of collapse?
  1. Identify the location of AEDS with posters, signs, markers, or other forms of communication other than on the AED itself?
  1. Perform routine maintenance or testing on all AEDs?
  1. 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?

Occupational Health and Safety

During the past 12 months, did your worksite: Yes No
  1. 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.
  1. Have a written injury and/or illness prevention program?
    Answer “yes” if there is a written policy, whether or not it is posted.
  1. 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.
  1. Encourage reporting of injuries and near misses?
    Answer “yes” if there is written and/or verbal encouragement to report injuries, illnesses, or near misses.
  1. 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.
  1. 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.
  1. 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.
  1. Provide all new workers formal, comprehensive training on how to avoid accidents or injury on the job?
  1. 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.).
  1. Have the following policies or benefits for employees been in place?
  1. 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.]
  1. Paid vacation time or personal days or hours to full-time, non-exempt employees).

Vaccine-Preventable Diseases (VPD)

During the past 12 months, did your worksite: Yes No
  1. Provide health insurance coverage with no or low out-of-pocket costs for influenza (flu) vaccination?
  1. Provide health insurance coverage with no or low out-of-pocket costs for vaccinations other than influenza (flu) (e.g., pneumococcal or Tdap vaccines)?
  1. 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. IF NO, PLEASE PROCEED TO QUESTION NUMBER 121.
  1. 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.
  1. 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.
  1. 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.

Community Resources

During the past 12 months, did your worksite: Yes No
  1. Provide employees with health related information, programs, or resources from any of the following organizations (not including your own organization)?
    Respond “yes” or “no” to all questions. Answer “yes” if health information, programs, or resources are provided in-person or online; on-site or off-site; or in group or individual settings.
  1. State/local public health agency
  1. Health insurance plan
  1. Health management program and/or wellness program provider/vendor
  1. Workers compensation provider
  1. Health-related organizations (such as the American Heart Association, American Cancer Society, etc).
  1. Health insurance broker
  1. Hospital
  1. State/local public health agency
  1. State/local public health agency
  1. Other

    Respond “yes” 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.
  1. Receive consultation, guidance, advise, training, and/or direction from any of the following organizations related to the design and delivery of a worksite wellness program?
    Respond “yes” or “no” to all questions.
  1. State/local public health agency
  1. Health insurance plan
  1. Health management program and/or wellness program provider/vendor
  1. Workers compensation provider
  1. Health-related organizations (such as the American Heart Association, American Cancer Society, etc).
  1. Health insurance broker
  1. Hospital
  1. YMCA
  1. Community or Business Organization (Wellness Council, Chamber of Commerce or other business group)
  1. Other

    Respond “yes” 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.
  1. Participate in any Community Coalitions focused on health or business and community partnerships?
Optional Employee Characteristics

Please complete this section if you are completing this tool for a state health department or are working with other partners. Otherwise scroll down to the bottom and click on the “Find Your Score” button.

Number of employees:

Sex: % %

Age group: % % % % %

Average age: years old

Racial/ethnic group: % % % % % % %

Work status: % % %

Job type: % %

Education level: % % % % %

Business type: For-profit Non-profit Non-profit/Government

Industry: Agriculture, Forestry, Fishing and Hunting Mining, Quarrying, and Oil and Gas Extraction Retail/Wholesale Trade Accommodation & Food Services Professional, Scientific, & Technical Services Transportation, Warehousing, & Utilities Health Care & Social Assistance Real Estate & Rental & Leasing Finance and Insurance Information Construction Educational Services Manufacturing Administrative & Support & Waste Management & Remediation Services Arts, Entertainment, and Recreation Public Administration Other

Medical insurance provided to employees? Yes No

Elements of worksite health promotion programs offered at your organization:
Health education (e.g., skills development and behavior change classes; awareness building brochures, posters)
Links to related employee services (e.g., referral to employee assistance programs [EAPs])
Supportive physical and social environment for health improvement (e.g., tobacco-free policies, subsidized gym memberships)
Integration of health promotion into your organization’s culture (e.g., health promotion being part of business’ mission statement)
Employee screenings with adequate treatment and follow up (e.g., Health Risk Assessments (HRAs) and biometric screenings)

Workplace Wellness Solutions, LLC

(907) 312-0157