Workplace Award Application

Transcription

1 * 1. Contact Information Point of Contact Name Point of Contact Title Business Name Business Address City/Town State/Province -- select state -- ZIP/Postal Code Point of Contact Address Point of Contact Phone Number * 2. Total Number of Employees (Including full-time, part-time and contracted) 1

2 * 3. Nature of Business Agriculture College/University Communication Construction Education Finance Government Healthcare Manufacturing nprofit organization Retail Services Transportation Utilities Wholesale Other (please specify) * 4. How many office locations benefit from your culture of well-being? Instructions: The questions for the workplace application are tied to evidenced-based strategies identified to support workplace wellbeing. The strategies should be newly implemented or can be existing tactics that have been expanded or enhanced between Jan. 1, 2017 and September 1, If you respond "YES", additional details including a description, impact, outcome, effort and sustainability is required. As appropriate include policy or handbook language that you have adopted to support the strategy. 2

3 Eat Well * 5. Does your worksite have a garden(s) that allows employees to access plots for growing herbs, fruits and vegetables for consumption by their family and friends? 6. Detailed Description: Describe in detail when you implemented the garden - what was developed, changed, enhanced or improved. 7. Impact: What was the impact? Why was it done? What changed or improved? What did you learn? 8. Outcome: What measurable outcomes occurred or were observed as a result of adding a garden? Number of people benefited? 9. Effort: How did you accomplish implementing a worksite garden? Who was involved? Explain the degree of effort it took to complete. 3

4 10. Sustainability: Describe how you plan to sustain the workplace garden. What is in place to ensure it continues into the future? Eat Well * 11. Does your workplace offer healthy food and/or beverages through sources such as vending machines or employee "snack drawers"? 12. Detailed Description: Describe in detail your vending machine and/or snack drawer program. 13. Impact: What has been the impact of offering healthier choices? Why was it done? 14. Outcome: What measurable outcomes occurred or were observed as a result of providing healthier options? Number of people benefited? 4

5 15. Effort: How did you accomplish changing the vending machines or snack drawers to provide healthier options? Who was involved? Explain the degree of effort it took to complete. 16. Sustainability: What is in place to ensure the healthy vending/snack drawer continues into the future? Eat Well * 17. Does your worksite regularly initiate opportunities onsite for employees to get access to locally grown produce (for example, through farm stands, farmers' markets, or community supported agriculture arrangements)? 18. Detailed Description: Describe in detail your program to provide locally grown produce. 19. Impact: What has been the impact? Why was it done? What changed or improved? What did you learn? 5

6 20. Outcome: What measurable outcomes occurred or were observed as a result of offering locally grown produce? Number of people benefited? 21. Effort: Explain the degree of effort it took to implement a locally grown produce program. 22. Sustainability: What is in place to ensure the program continues into the future? Eat Well * 23. Does your worksite provide weight management programs either in-person or online; onsite or offsite; in group or individual settings; through vendors, onsite staff, health insurance plans or programs, community groups or other practitioners? 24. Detailed Description: Describe in detail the weight management programming offered. 6

7 25. Impact: What is the impact? How many employees have benefited? 26. Outcome: What measurable outcomes occurred or were observed due to offering weight management programs? 27. Effort: Explain the degree of effort it took to implement the programs. 28. Sustainability: What is in place to ensure the programming continues into the future? Eat Well * 29. Does your worksite have a written policy (or formal communication with employees) that makes healthier food and beverage choices available during meetings when food is served? 7

8 30. Detailed Description: Describe in detail the policy adopted to support healthy meetings. 31. Impact: What has been the impact of adopting a healthy meeting policy? Why was it done? What changed or improved? What did you learn? 32. Outcome: What measurable outcomes occurred or were observed as a result of adopting a healthy meeting policy? 33. Effort: Who was involved to implement this policy? Explain the degree of effort it took to complete. 34. Sustainability: What is in place to ensure that healthy options are provided at meetings? Move More * 35. Does your worksite support or encourage employees to be physically active before, during or after the work day? For example, does your worksite provide a place for walking/jogging, offer individual or group fitness programs or provide access to facilities that support physical activity? 8

9 36. Detailed Description: Describe in detail how you support your employees to be physical active before, during or after work. 37. Impact: What has been the impact? 38. Outcome: What measurable outcomes occurred or were observed? Number of people benefited? 39. Effort: Who was involved to adopt a worksite that supports physical activity? Explain the degree of effort it took to implement. 40. Sustainability: Is the program sustainable? What is in place to ensure it continues into the future? Move More * 41. Does your worksite use a variety of strategies to encourage employees to commute to work by either walking or biking? Such strategies may include: providing access to secure bike storage, providing incentives for biking or walking to work, or providing showers and/or changing facilities. 9

10 42. Detailed Description: Describe in detail your policy or strategy to support active commuting. 43. Impact: What was the impact? What changed or improved? What did you learn? 44. Outcome: What measurable outcomes occurred or were observed as a result of encouraging employees to walk orbike to work? Number of people benefited? 45. Effort: Who was involved in adopting this change? Explain the degree of effort it took to complete. 46. Sustainability: What is in place to ensure that biking or walking to work continues into the future? Feel Better 10

11 * 47. Does your worksite offer financial rewards (or other incentives) to encourage employees to engage in healthy behaviors? 48. Detailed Description: Describe in detail the financial incentive program you have in place. 49. Impact: What impact have you seen with this program? Why was it done? What has changed or improved since you implemented? 50. Outcome: What measurable outcomes occurred or were observed as a result? Number of people benefited? 51. Effort: Who was involved in deciding to implement this program? Explain the degree of effort it took to implement. 52. Sustainability: What is in place to ensure the program continues into the future? 11

12 Feel Better * 53. Does your worksite provide stress management programs either in-person or online; onsite or offsite; in group or individual settings; through vendors, onsite staff, health insurance plans or programs, community groups or other practitioners? 54. Detailed Description: Describe in detail the stress management program you offer to employees. 55. Impact: What has been the impact of this program? Why was it done? What have you changed or improved since implementing the program? 56. Outcome: What measurable outcomes occurred or were observed as a result providing this program? Number of people benefited? 57. Effort: Who was involved in implementing or approving this program for employees? Explain the degree of effort it took to complete. 58. Sustainability: What is in place to ensure the program continues into the future? 12

13 Feel Better * 59. Does your worksite have a written policy prohibiting all forms of tobacco use (i.e. cigarettes, chewing tobacco and electronic cigarettes)? 60. Detailed Description: Describe in detail when this strategy was done and what was developed, changed, enhanced or improved. Include how you actively enforce the written policy which may include: posting signs, not having ashtrays onsite, or communicating policy banning tobacco use through various communication channels. 61. Impact: What was the impact? Why was it done? What changed or improved? 62. Outcome: What measurable outcomes occurred or were observed as a result implementing? Number of people benefited? 63. Effort: Who was involved with implementing the policy? Explain the degree of effort it took to complete. 13

14 64. Sustainability: What is in place to ensure it continues into the future? Feel Better * 65. Does your worksite refer tobacco users to a tobacco cessation telephone quite line (i.e. Quitline Iowa)? 66. Detailed Description: Describe in detail your tobacco cessation referral program. 67. Impact: What has been the impact? 68. Outcome: What measurable outcomes occurred or were observed as a result? Number of people benefited? 69. Effort: Who was involved to implement this program? Explain the degree of effort it took to complete. 14

15 70. Sustainability: What is in place to ensure the referral program continues into the future? Feel Better * 71. Does your worksite provide free or reduced costs for prescription tobacco cessation medications and/or over-the-counter nicotine replacement products? 72. Detailed Description: Describe in detail your nicotine/tobacco cessation program. 73. Impact: What has been the impact? 74. Outcome: What measurable outcomes occurred or were observed as a result of offering free/reduced prescription or over the counter nicotine/tobacco cessation? Number of people benefited? 15

16 75. Effort: Who was involved in implementing this offering to employees? Explain the degree of effort it took to complete. 76. Sustainability: What is in place to ensure the offering continues into the future? Feel Better * 77. Does your worksite provide a private space (other than a restroom) that may be used by an employee to express breast milk? 78. Detailed Description: Describe in detail your breast feeding program. 79. Impact: What was the impact of implementing this policy or program? What changed or improved? What did you learn? 16

17 80. Outcome: What measurable outcomes occurred or were observed as a result? Number of people benefited? 81. Effort: Who was involved in implementing the policy/program? Explain the degree of effort it took to complete. 82. Sustainability: What is in place to ensure the policy/program continues into the future? * 83. Does your worksite allow employees to have flexible schedules? 84. Detailed Description: Describe in detail your flexible schedule policy/program. 85. Impact: What was the impact? Why was it done? What changed or improved? What did you learn? 17

18 86. Outcome: What measurable outcomes occurred or were observed as a result of adopting a flexible schedule policy/program? Number of people benefited? 87. Effort: Who was involved to bring this program to implmenetion? Explain the degree of effort it took to complete. 88. Sustainability: What is in place to ensure the flexible schedule program/policy continues into the future? Feel Better * 89. Does your worksite make dental insurance available to all eligible employees? 90. Detailed Description: Describe in detail your dental offerings. 18

19 91. Impact: What has been the impact of offering dental insurance? 92. Outcome: How many employees use their dental insurance benefits? 93. Effort: Who was involved to make the decision to offer dental insurance as a benefit? 94. Sustainability: What is in place to ensure dental insurance continues to be offered as a benefit into the future? Feel Better * 95. Does your worksite have an active employee wellness committee involved in planning and implementing health promotion programs? 19

20 96. Detailed Description: Describe in detail your wellness committee structure. 97. Impact: What has been the impact of the wellness committee? 98. Outcome: What measurable outcomes have occurred by this committee? 99. Effort: Who was involved on the committee? Who chairs the committee? 100. Sustainability: What is in place to ensure the committee continues into the future? Feel Better * 101. Does your worksite support employee participation in volunteer efforts in the community? 20

21 102. Detailed Description: Describe in detail your volunteering program or policy Impact: What has been the impact of your volunteer program? Why was it done? 104. Outcome: What percentage of your employees volunteer per month/quarter/year? What outcomes have you observed since adopting a volunteer policy? 105. Effort: Who was involved to implement a volunteer program/policy? Explain the degree of effort it took to complete Sustainability: What is in place to ensure the volunteer program/policy continues into the future? Feel Better * 107. Does your worksite sponsor or promote biometric screening for employees that include(at a minimum) tests for cholesterol, glucose, blood pressure, and body mass index (BMI)? 21

22 108. Detailed Description: Describe in detail your biometric screening program Impact: What has been the impact of this program? Why was it done? What has changed or improved? 110. Outcome: What measurable outcomes occurred or were observed as a result of offering a biometric screening program? Number of people benefited? 111. Effort: Who was involved in implementing a biometric screening program? Explain the degree of effort it took to complete Sustainability: What is in place to ensure the biometric screening program continues into the future? 22