2. Which of the following does your business / organization offer to employees? (Check all that apply)

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1 Assessment Tool Please refer to scoring instructions on the last page and visit our website at for additional resources and technical assistance. Section 1: PROGRAMS & BENEFITS 1. Which of the following does your business / organization offer to employees? (Check all that apply) Wellness Program Stress Management Program Safety & Injury Prevention Program Chronic Condition Self-management Nutrition Education Community service opportunities Physical activity opportunities Employee Assistance Program (EAP) Tobacco Cessation Program Programs available to family members Financial Management Program Other (please specify) 2. Which of the following does your business / organization offer to employees? (Check all that apply) Comprehensive Health Insurance Long-term disability Dental Insurance Child care reimbursement Vision Insurance Elder care reimbursement Coverage of low-cost screening and treatment Flexible work schedules services for mental health and addictions Tuition Reimbursement Flexible Spending Account Paid Family Leave for parents, Paid Sick Leave guardians and caregivers Paid Bereavement Leave Legal assistance Paid Vacation Days Retirement Plan Short-term disability Other (please specify)

2 Section 2: POLICIES & SUPPORTS 3. Which of the following employee mental wellness policies does your organization have in place? (Check all that apply) Harassment and Retaliation Policy Healthy Meeting Policy that requiring healthy Tobacco Free Workplace Policy food and breaks Drug Free Workplace Policy Confidentiality Policy to safeguard employee Pre-employment Drug Testing Policy health information Workplace Gambling Policy Breastfeeding Policy Flex Time Policy for physical activity Workplace Violence Policy Other (please specify) 4. Which of these additional employee wellness supports does your organization provide? (Check all that apply) Bias Reporting and Response System Annual health screening that includes mental Health Risk Assessment health screening Coordinated disability and leave management Addiction and mental health referrals Peer mentoring Employee health clinic Chronic disease case management Other (please specify)

3 Section 3: PHYSICAL ENVIRONMENT 5. Which of the following does your organization provide? (Check all that apply) Break room with a refrigerator and microwave Locker room with showers Healthy food for purchase Exercise room Lactation room for nursing mothers Secure bicycle parking Quiet work space Standing work stations Space where employees can engage in Work areas with natural light relaxation activities or take a nap Ergonomic assessments Tobacco-free outdoor area Protection of physical safety Other (please explain) Section 4: TRAININGS 6. Which of the following trainings does your organization provide? (Check all that apply) Diversity and Cultural Competence Suicide Prevention Harassment and Sexual Harassment Mental Health First Aid Communication Skills Crisis Response Mindfulness Emergency Preparedness Problem-solving Skills Americans with Disabilities Act (ADA) and Conflict Resolution reasonable accommodation Organizational Change and Transition Trauma-informed Practice Stress Management Depression Awareness Other (please explain)

4 Section 5: COMMUNICATION 7. How does your organization inform employees about resources, programs and policies? (Check all that apply) New Employee Orientation Wellness and Benefits Newsletter Departmental Orientation In-service or Staff Meeting Employee Handbook Brochures, posters, pamphlets or newsletters Website or Online Other (please explain) 8. Which of the following opportunities does your organization provide for employee participation in decisions regarding workplace issues? (Check all that apply) Wellness Committee Employee Satisfaction Survey Safety Committee Wellness Survey Diversity Committee Other (please explain) 9. Which of the following statements is TRUE about the attitudes/perspectives of LEADERSHIP in your organization? (Check all that apply) Having a mental health friendly workplace is important. The health and well-being of employees is genuinely a concern. Equity and diversity are values that are clearly communicated. Open communication is encouraged. Evaluation feedback processes are available at all levels.

5 Scoring Instructions Add up the number of total checks for each section and write it in the box marked. Do not count None of the above. Write the total for each section in the column on the right. Add up your total score. Total Possible for Section Section 1: PROGRAMS & BENEFITS 30 Section 2: POLICIES & SUPPORTS 20 Section 3: PHYSICAL ENVIRONMENT 14 Section 4: TRAININGS 16 Section 5: COMMUNICATION 20 TOTAL SCORE TOTAL SCORE 75 to 100 Great work! Consider looking at the scores in each section to see where you might have room for improvement. 50 to 74 Your organization or department is well on its way to workplace mental wellness for employees! Consider sections where you scored lowest and see if there is something new that you can implement. 25 to 49 Great starts and plenty of opportunity to grow! Consider starting with what seems most feasible. Maybe form a team to help determine needs and strengths of your organization, and work with leadership to gain their support. Below 25 This is just the beginning! Go to our website to help you get started! For additional resources to help you improve employee mental wellness in your organization, please visit the Mind Your Work webpage at: To submit a request for technical assistance please your completed form to: info@mindyourmindproject.org

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