A strong foundation for employee health improvement

1.      To what extent does the senior management in your organization actively and visibly support the Corporate Health and Wellness Program?

__ No support for the Corporate Health and Wellness Program

__ Support, but not at senior level

__ Support at senior level, but not visible to workers

__ Strong and visible Corporate Health and Wellness Program support

Comments:

2.      Is the Corporate Health and Wellness Program tied to your organization’s mission statement?

__ No

__ Yes, the Corporate Health and Wellness Program is tied to business plan OR mission  statement

__ Yes, the Corporate Health and Wellness Program is tied to both business plan and mission statement

Comments:

3.      Is there an worker within your organization whose job responsibilities include Corporate Health and Wellness Program coordination?

__ No

__ Yes, but has little time available to dedicate to Corporate Health and Wellness Program

__ Yes, and has at least component of the job dedicated to Corporate Health and Wellness Program

__ Yes, and has at least one full-time position dedicated to Corporate Health and Wellness Program

__ Yes, and has at least component of the job dedicated to wellness AND has a background that includes Corporate Health and Wellness Program qualifications

__ Yes, our organization has at least one full-time position dedicated to health improvement AND the worker’s background includes Corporate Health and Wellness Program qualifications

Comments:

4.      Does your organization have an active wellness committee with diverse representation?

__ No (does not have a Wellness Committee, or has a committee that doesn’t meet)

__ Yes, we have a Wellness Committee, but with limited representation

__ Yes, we have a Wellness Committee with widespread representation

__ Yes, we have a Wellness Committee with widespread representation AND committee involvement is a component of each representative’s job responsibilities

Comments:

5.      Does your organization have an annual budget for Corporate Health and Wellness Program expenses? (Corporate Health and Wellness Program expenses may be associated with offering a health assessment, paying for behavior change programs/coaching programs, covering rewards that encourage healthy behaviors, subsidizing healthy food options, communications and activities around specific health topics, fitness centers/walking paths, etc).

__ No

__ Yes, but funds are earmarked for Corporate Health and Wellness Programs (e.g. only for Weight Watchers or fitness discounts) and do not meet all existing Corporate Health and Wellness Program needs

__ Yes, funds are available to meet current Corporate Health and Wellness Program needs

Comments:

6.      Does your organization have a plan for engaging workers in the Corporate Health and Wellness Program?

__ No

__ Yes, we have a communications plan for our Corporate Health and Wellness Program

__ Yes, we have a communication plan AND we offer meaningful incentives or rewards (such as premium discounts or debit cards) for the Corporate Health and Wellness Program to engage in healthy behaviors.

Comments:

A data-based approach to the Corporate Health and Wellness Program

7.      Does your organization have clearly stated Corporate Health and Wellness Program objectives and priorities for employee health improvement?

__ No

__ Yes

__ Yes, data (e.g. HRA, claims, productivity) are the basis for defining Corporate Health and Wellness Program objectives or priorities

__ Yes, data AND evidence-based best practices are a basis for defining Corporate Health and Wellness Program objectives or priorities

__ Yes, data and best practices are basis for defining Corporate Health and Wellness Program objectives or priorities as well as measuring Corporate Health and Wellness Program progress (evaluation)

Comments:

8.      Has your organization completed a Health Risk Assessment?

__ No

__ Yes, but more than 2 years ago

__ Yes, within the last two years, and achieved a participation rate of less than 50 percent

__ Yes, within the last two years, and achieved a 50 percent – 79 percent participation rate

__ Yes, within the last two years, and achieved an 80 percent or greater participation rate

Comments:

A workplace environment that supports healthy behaviors

9.      Does your organization’s tobacco reduction strategy reflect best practices?

(Check all that apply)

__ A no-tobacco use policy that includes both buildings AND grounds

__ 100 percent coverage for the cost of over-the-counter nicotine replacement therapy

__ Worker access to – and strong promotion of — a tailored stop-smoking program

Comments:

10.  Does your organization provide opportunities (time and places) for physical activity during the work day?

__ No

__ Yes, indoor places for physical activity (on-site fitness center) OR outdoor places for physical activity (walking paths)

__ Yes, both indoor AND outdoor places for physical activity

__ Yes, indoor and outdoor opportunities AND workers can use work time for physical activity

Comments:

11.  Does your organization promote healthy eating by providing access to fruits and vegetables?

__ No

__ Yes, fruits and vegetables are available at the workplace (in vending machines, break areas, or cafeterias)

__ Yes, fruits and vegetables are available and discounted at the workplace

Comments:

Benefits that support employee health improvement

12.  Does your organization provide workers with self-care resources?

(Check all that apply)

__ Distribution of self-care books

__ internet-based access to health information

__ Nurse advice line

Comments:

13.  Which of the following preventive services are covered at 100 percent by your organization’s health benefits?

(Check all that apply)

__ Vision screening

__ Hearing

__ Immunizations (per CDC/ACIP recommendations)

__ Radiology

__ Laboratory services

__ STD screening

__ Preventive medical examination for adults

__ Cancer screen (includes: colon, cervical, breast, prostate and ovarian cancers)

__ Contraceptive management

Comments:

14.  Which of the following are included in your organization’s pharmacy benefit?

(Check all that apply)

__ Mail order or other 90-day supply option for medications

__ Specialty pharmacy network

__ Incentive-based tiered formulary design

Comments:

15.  Do your organization’s health benefits provide coverage for behavioral health (such as depression, mental illness, counseling, stress management, and chemical dependency)?

__ Yes, at the same level as medical benefits

__ Yes, but at a reduced level (less coverage) than medical benefits

__ No coverage for mental or behavioral health

Comments: