Completed applications must be submitted by January 2, 2018.

Transcription

1 Contact Information Primary Employer Contact Nominator Information (if different) Name: Name: Title: Title: Company: Company: Address: Address: City/State: City/State: Phone: Phone: Number of employees: Completed applications must be submitted by January 2, We acknowledge the Utah Council for Worksite Health Promotion upon which our Healthy Workplaces Application is modeled.

2 Section 1. Program Governance Worksite wellness programs are as unique as the companies offering them. To help us better understand your program from administration and management to obtaining executive support and commitment - please check as many activities listed below that are applicable to your worksite wellness program. For award consideration please note: Platinum check at least 6 activities in this content section Gold check at least 3 activities in this content section Silver check at least 2 activities in this content section Policy Resources Outcomes Program offered to all employees (required for all award levels) Mission Statement (required for Platinum and Gold award levels) Formal budget for wellness program (required for Platinum award level) Written Policy/Procedure Manual Program offerings are extended to employee s spouse Letter of support from upper management Wellness committee Wellness coordinator/ champion Employer has a written implementation plan for wellness program The CEO/CFO regularly communicate to employees on worksite health promotion A variety of methods or techniques used to disseminate health/wellness information Community resources are actively promoted Senior management participation in wellness activities Use a Health Risk Appraisal tool to measure health status of employees on a regular schedule (e.g., yearly) Needs assessment survey is conducted as appropriate Annual Wellness Report made available to management/ employees Economic impact of the wellness program is measured utilizing medical claims data, risk factors, and other measures 2

3 Section 2. Healthy Behaviors Employers can promote healthy behaviors in a number of ways. Smoking and excessive alcohol consumption are two major risk factors for chronic disease. The activities listed below indicate a number of ways healthy behaviors can be promoted at the worksite. Check the activities that are applicable to your worksite. For award consideration please note: Platinum check at least 6 activities in this content section Gold check at least 3 activities in this content section Silver check at least 2 activities in this content section Policy Resources Outcomes Tobacco Free Worksite/ Campus Drug and Alcohol Free Worksite policy Flexible Work Hours policy to enable employees to participate in wellness activities or active commute modes Offer bio-metric screenings on annual basis Programs to support tobacco cessation Provide access to Employee Assistance Programs (EAP) Drug and alcohol abuse services are promoted/ provided On-going employee recognition program Regular opportunities are provided for employee career growth and development Stress management information, programs or classes are offered Wellness information provided in a number of formats Reduction in smoking as measured by health risk assessment or tobacco specific survey Reduction in alcohol and substance abuse risk factors as measured by health risk assessment, specific survey, claims data Participation levels in wellness programs show year to year increases Reduction in stress and worklife conflicts as measured by employee survey or Health Risk Assessment Track bio-metric screening data 3

4 Section 3. Nutrition Poor nutrition is a modifiable risk factor for chronic disease. Promotion of healthy eating at the worksite can help reduce the risk of developing high cholesterol, developing Type 2 diabetes, developing high blood pressure and obesity. In order to support good nutritional choices at the workplace, healthy foods must be both available and affordable. Check the activities that are applicable to your worksite. For award consideration please note: Platinum check at least 6 activities in this content section Gold check at least 3 activities in this content section Silver check at least 2 activities in this content section Policy Resources Outcomes Written policy requiring nutritional information on cafeteria offerings Healthy food choices are provided in vending machines Written policy ensuring healthy food/beverage options are available at work meetings/events Policy supporting breastfeeding mothers Fruit/healthy food offered instead of candy dish Employees have access to refrigerator, microwave or sink Healthy food preparation practices or smaller portion sizes provided in on-site cafeteria Promotes nutritious eating messages to employees Farmer s market/worksite vegetable gardens Provides educational information, classes or programs on nutrition Room is provided for nursing mothers Weight watchers or similar program offered to employees Incentive programs for healthy eating behaviors Free water options provided Behavior change is measured by employee survey or observational survey Number of items in cafeteria that meet healthy criteria is tracked Number of items in vending machines that meet healthy criteria is tracked Participation in nutrition educational programs is tracked Data collected from employee or observational surveys show healthier options are offered at work meetings 4

5 Section 4. Physical Activity Employers can undertake a number of activities to encourage regular physical activity. From the list below, please check the activities that are applicable to your worksite. Check the activities that are applicable to your worksite. For award consideration please note: Platinum check at least 6 activities in this content section Gold check at least 3 activities in this content section Silver check at least 2 activities in this content section Policy Resources Outcomes Flex time or work time to enable employee participation in wellness activities Providing a subsidy for offsite gym or recreation programs Promote active forms of transportation commuting to and from work (i.e. discount passes for rail or bus) Routine stretch breaks or pre -work warm up before or during the work day Sponsors corporate teams/ leagues Provides physical activity information, classes or programs Provides onsite fitness center Promotes and/or creates walking trails/paths/maps near workplace or walking clubs Encourage use of stairs Provides bicycle racks Offers bike sharing program (e.g. Zagster, Citi Bike, etc.) Offers car sharing program (e.g. Zipcar, Enterprise Carshare, Car2go, Etc.) On demand ride services (e.g. Uber, etc.) Shuttle service to and from worksite to encourage use of public transportation services Incentives for physical activity participation Provides/subsidizes wearable devices Provides sit/stand-up desks Behavior change is measured by employee survey or observational survey (i.e., increased physical activity levels of employees) Measured number of employees who participate in fitness center/gym memberships/leagues/teams/ walking clubs Observational survey on use of walking paths/trails by employees 5

6 Section 5. Safety Employers have a number of ways to promote safety at the worksite. These activities include establishing written and monitored policies as well as providing resources such as making Automated External Defibrillators (AEDs) available at the worksite, providing safety and accident prevention classes, and maintenance of a resource center. Check the activities that are applicable to your worksite. For award consideration please note: Platinum check at least 6 activities in this content section Gold check at least 3 activities in this content section Silver check at least 2 activities in this content section Policy Resources Outcomes Seat belt use policy for driving or riding in company owned vehicles Policy on employee training in Automated External Defibrillators (AEDs) and CPR Employers and employees are trained on recognizing signs of heart attack and stroke Company has an emergency plan Safety committee Seat belt/helmet signage in parking lots Training is provided to employees on safety, emergency procedures and accident prevention AEDs are available in the workplace Employer maintains resource center, print or online, concerning safety and accident prevention on a variety of topics and in a variety of settings (i.e. home, work, pool or beach, driving, etc.) First aid kits are available Company has installed appropriate safety devices, measures Behavior change is measured by employee survey or observational survey (i.e., increased safety belt usage) Measured number of employees participating in classes or training Rate change/number of work related accidents or Workman s Compensation cases in line with industry standards Complete an emergency preparedness drill annually 6

7 Section 6. Prevention and Disease Management Activities that employers may undertake to encourage employee use of appropriate preventive and disease management services are listed below. Please check the activities that are applicable to your worksite. For award consideration please note: Platinum check at least 6 activities in this content section Gold check at least 3 activities in this content section Silver check at least 2 activities in this content section Policy Resources Outcomes Recommended prevention services are promoted Recommended disease management services are promoted Flexible work hours policy to receive recommended services Provides and promotes to employees information on medical self-care Provides and promotes educational information to all employees regarding recommended Adult Preventive Services Flu shots or flu shot vouchers are provided Counseling and education to employees to help address chronic diseases and related risk factors Onsite medical clinic Provide incentives to encourage employees to comply with recommended preventative or disease management services and medications Provide access to decision support tools to help employees select a health care provider or treatment option Provide private room/space for employees to test or administer medication Employees receive recommended screenings as measured by health risk assessment or survey Number or preventive services provided at the worksite Number of disease management services provided at the worksite Number of clinic visits Data collected from insurance carrier on preventive screenings your company completed 7

8 Employer Wellness Program Synopsis All applicants should complete this form. Provide a concise summary of the employer wellness program in 1000 words or less (e.g. information about your company, goals and objectives of the wellness program, program design, how the program was implemented, outcomes, and how you measure success.) A best practice exchange document will be produced and distributed at the recognition event. Your summary should be suitable for inclusion in this best practice exchange document. Final content approval from you as well as your company logo will be requested. For reference, a copy of the 2017 Healthy Workplace best practice document can be viewed online here. 8

9 2018 Program Outcome Form #1 Directions: Use this form to report on wellness activities or initiatives that were completed at the worksite. Platinum must complete 2 outcome forms Gold must complete 1 outcome form Employer Name Program Name Program Focus Start Date/End Dates Program Description: Describe all aspects of the program including how you advertised the program, incentives, program materials. Participation: Who was your target population? What percent of employees completed the program? What were the results? 9

10 2018 Program Outcome Form #1 (continued) Evaluation: What aspects were successful? What would you do differently? What aspects of the program, if any, will you change next year? Provide an example of an individual or company wide success story. 10

11 2017 Program Outcome Form 2018 Program Outcome Form #2 Directions: Use this form to report on wellness activities or initiatives that were completed at the worksite. Platinum must complete 2 outcome forms Gold must complete 1 outcome form Employer Name Program Name Program Focus Start Date/End Dates Program Description: Describe all aspects of the program including how you advertised the program, incentives, program materials. Participation: Who was your target population? What percent of employees completed the program? What were the results? 11

12 Program Outcome Form #2 (con t) (continued) Evaluation: What aspects were successful? What would you do differently? What aspects of the program, if any, will you change next year? Provide an example of an individual or company wide success story. 12

13 Completed applications should be submitted by January 2, To submit your completed application electronically simply hit the submit button below. SPECIAL THANKS The Healthy Workplace Employer Recognition program is an initiative of The Business Council of Fairfield County s Wellness Roundtable. APPLICATIONS CAN BE MAILED, FAXED OR Healthy Workplace Employer Recognition One Landmark Square, Suite 300 Stamford, CT Fax: tcourt@businessfairfield.com Submit Reset 13