American Cancer Society
HealthLinks Washington
Employer Survey (Baseline) – 1422
Organization ID:
Date: ______
The survey we’re doing today addresses prevention of cancer and other chronic diseases at the worksite. The questions are about best practices that affect key health behaviors like tobacco use, physical activity, and nutrition. There are six sections in the survey: Worker/Worksite Characteristics, Health Insurance Benefits, Worksite Wellness Committees,Worksite Policies, Employee Programs, and Communication. The programs and services discussed in this survey are separate from Employee Assistance Program (EAP) services.
Worker/Worksite Characteristics
This section is about your company’s employment and workforce demographics.
Note to interviewer: Some companies don’t collect workforce demographics. Ask respondents all of the questions below and if they do not collect certain workforce demographic information, simply note “don’t collect” in the margins. If the respondent is unsure about percentages, ask for the number of employees and calculate percentages later.
- What is [your company’s] primary industry sector/area of business?
Construction Manufacturing
Education Natural Resources and Mining
Financial Activities Professional and Business
Government Transportation and Utilities
Information Wholesale and Retail Trade
Leisure and HospitalitySocial Services
Health Care Other (specify) ______
- How many total employees does [your company] employ? ______
- Is this [your organization’s] headquarters? Yes No
- What is the average annual salary among employees at [your company]? ______
- What percentage of your employees are Hispanic or Latino? ______
- Please indicate the percentage of employees who belong to the following racial groups.
African-American/Black___%
Caucasian/White___%
American Indian/Alaska Native___%
Asian/Pacific Islander___%
Multi-racial___%
Other (specify)___%
Total100%
- Please indicate the percentage of employees by age:
18-44___%
45-64___%
65+___%
Total100%
- Please indicate the percentage of employees by gender:
Male___%Female___%
- What percentage of your workforce is employed full-time? ______
- What percentage of your workforce belongs to a union? _____
- What is the annual employee turnover rate at [your company]? ______
Health Insurance Benefits
This section is about your company’s health insurance benefits.
Yes / No12. / Does [your company]offer health insurance to its employees? / 1 / 0
12a. / [If yes] Who is your health insurance provider? [write in]______
If yes, go to #13. If no, go to #16.
13. / Approximately what percentage of [your company’s] employees are eligible for health insurance through your organization? / _____%
14. / Approximately what percentage of theemployees who are eligible for health insurance are actually enrolled in [your company’s] health insurance plan? / _____%
Yes / No
15. / Is [your company] self-insured for health insurance? / 1 / 0
Self-insured means that your company is operating its own health insurance plan, as opposed to purchasing coverage from an insurance company. While your company might be paying a third party to manage the plan, it is your company that designs the plan and pays for each claim out of its own budget.
Worksite Wellness Committee
This section is about your company’s wellness committee.
Yes / No16. / Does [your company] have a worksite wellness committee? / 1 / 0
If yes, go to #17. If no, go to #29.
Yes / No
17. / Is the wellness committee also the health and safety committee? / 1 / 0
17a. / If the wellness committee serves as another committee as well, how much committee time is spent specifically on wellness?
4 All or almost all2 About half
3 More than half1 Less than half
18. / How long has the wellness committee been in place? [write in] ______
19. / How often does the wellness committee meet?
5 More than once a month2 Once a quarter
4 Once a month1 Less than once a quarter
3 Every other month
Yes / No
20. / Do members of senior management serve on the wellness committee? / 1 / 0
Yes / No
21. / Are there non-management members on the wellness committee? / 1 / 0
22. / How many people serve on the wellness committee?______
23. / In an average month, how many hours does the wellness committee collectively spend on planning wellness programs? This includes time spent during meetings on wellness-related subjects, plus time spent outside of the meetings on such activities as recruiting coworkers, promoting wellness activities, managing wellness events, etc.
6 Less than 1 hour3 5-6 hours
5 1-2 hours2 7-8 hours
4 3-4 hours1 8 hours or more
24. / How many wellness committee members typically attend meetings?
4 All or almost all2 About half
3 More than half1 Less than half
25. / How many of the various departments or work areas in your organization are represented on the wellness committee?
4 All or almost all2 About half
3 More than half1 Less than half
Yes / No
26. / Does the wellness committee have a written action plan, work plan, or goals? / 1 / 0
27. / How often are the wellness committee’s recommendations or activities implemented?
(Examples are walking groups, tobacco bans, and healthy food policies)
5 Almost always2 Rarely
4 Often1 Never or almost never
3 Sometimes
28. / Does management provide resources such as supplies and staff time, for wellness committee activities when needed?
5 Almost always2 Rarely
4 Often1 Never or almost never
3 Sometimes
Wellness Budget & Staffing
This section is about [your company’s] wellness budget and staffing.
Yes / No29. / Does your company have a budget dedicated to health promotion or wellness? This does not include money spent on health insurance coverage or one-time purchase of prizes from the company. / 1 / 0
If yes, go to #30. If no, go to #31.
30. / What is the approximate annual budget for wellness?______
Yes / No
31. / Does your company have a health promotion or wellness coordinator? This would be an individual whose sole job function is to coordinate health promotion and wellness, and the job is distinct from managing health insurance benefits. / 1 / 0
If yes, and if NOT respondent, go to #31a. If no, go to #32.
31a. / In an average week, how much time do they currently spend on managing all wellness activities, including wellness policies, programs, and communications?
1 Less than 30 minutes
2 30-59 minutes
3 60-89 minutes
4 90 minutes-119 minutes
5 2 hours – 149 minutes
6 150 minutes – 3 hours
7 More than 3 Hours
Yes / No
32. / Does your company have one or more staff members with health promotion and wellness coordinator responsibilities included as one of multiple job functions? / 1 / 0
If yes, and if NOT respondent, go to #32a. If no, go to #33.
32a. / In an average week, how much time do they currently spend on managing all wellness activities, including wellness policies, programs, and communications?
1 Less than 30 minutes
2 30-59 minutes
3 60-89 minutes
4 90 minutes-119 minutes
5 2 hours – 149 minutes
6 150 minutes – 3 hours
7 More than 3 Hours
Worksite Policies
This section is about your company’sworksite policies. The questions are about tobacco, physical activity, and nutrition.
33. / The next two statements describe tobacco use policies. Please tell me which one most closely describes the current policy:Statement 1: Employees are allowed to use tobacco on the premises, but not inside the building (company follows state law),OR / o
Statement 2: Employees and visitors are banned from using any form of tobacco throughout the premises, including company grounds and all vehicles on company grounds(company policy is a total ban) / 1
34. / How many employees are covered by this policy during paid work hours (examples ofemployees who might not be covered could be those who work outdoors or off-site)?
1 0-24%2 25-49%3 50-74%4 75% or more
Yes / No
35. / Does [your company] have any written policy restricting employee tobacco use? / 1 / 0
Yes / No
36. / Does [your company] have enforcement procedures for its rules on tobacco use? These could be specific to tobacco use or could fall under general enforcement procedures at your company. / 1 / 0
37. / Does [your company] have on-site food and beverage services, such as:
1 Cafeteria2 Food—vending machine3 Beverage—vending machine
4 No on-site food or beverage services 5 Other ______
If yes to any, go to #37a. If no, go to #42.
37a. / How many employees have access to the on-site food and/or beverage services?
1 0-24%2 25-49%3 50-74%4 75% or more
Yes / No
38. / Does [your company] provide healthy food or beverage choices for employees who want to eat healthy foods? This includes vending machines and on-site cafeterias.We will ask a separate question about healthy food at meetings later. / 1 / 0
If yes, go to #38a. If no, go to #42.
38a. / Which of the following types of food are provided?
1 Fruit 4 Green Salad
2 Vegetables 5 Other (specify)
3 Low-calorie snacks 6 None—only have beverage vending
38b. / Which of the following types of beverages are provided?
1 Bottled water 4 Sparkling water (unsweetened)
2 Low-fat or skim milk 5 None—only have food vending or cafeteria
3 Unsweetened tea
Yes / No
39. / Are healthy foods or beverages priced lower to encourage employees to buy them? / 1 / 0
If yes, go to #39a. If no, go to #40. / Yes / No
39a. / Does the company incur extra costs for subsidizing healthy foods or beverages?
39b (If yes) How much? ______/ 1 / 0
Yes / No
40. / Does [your company] call attention to healthy food choices by labeling them or posting nutritional content? / 1 / 0
Yes / No
41. / Does [your company] call attention to healthy beverage choices by labeling them or posting nutritional content? / 1 / 0
Yes / No
42. / Does [your company] have functioning water fountains or filtered water available? / 1 / 0
43. / Does [your company] intentionally provide healthy food at meetings or other work-related events?
5 Always or almost always2 Rarely
4 Often1 Never or almost never
3 Sometimes
If yes, go to #43a. If no, go to #44.
43a. / Which of the following types of food are provided?
1 Fruit 4 Water
2 Vegetables 5 Green Salad
3 Low-calorie snacks 6 Other (specify)
Yes / No
43b. / Is this a written policy? / 1 / 0
Yes / No
43c. / Does your company incur extra costs for offering healthy choices at meetings?
43d (If yes) How much? ______/ 1 / 0
Yes / No
44. / Does [your company] provide access to on-site physical activity facilities for employees, such as a fitness area? / 1 / 0
If yes, go to #44a. If no, go to #45.
44a. / How many employees have access to the physical activity facilities?
1 0-24%2 25-49%3 50-74%4 75% or more
Yes / No
45. / Does [your company] currently have negotiated discounts or financial incentives for employees to join commercial fitness centers?
If yes, go to #45a. If no, go to #46 / 1 / 0
45a. / Does your company pay any fees to the fitness center?
45b. (If yes) How much per year? ______/ 1 / 0
46. / Which of the following best describes [your company’s] policy about physical activity at the worksite?
1 Employees are not allowed to exercise or do any non-work activities during work hours.
2 Employees are not encouraged to exercise during paid work hours, but can exercise at lunch or during other breaks if they choose to.
3 We actively encourage employees to take short exercise breaks during paid work hours.
Yes / No
46a. / Is this a written policy? / 1 / 0
47. / How easy or difficult is it to change tobacco use, healthy eating, and physical activity policies at [your company]?
5 Very easy
4 Easy
3 Neither easy nor difficult
2 Difficult
1 Very difficult
0 Not possible (for example, this is a site, and headquarters makes all policy-related decisions)
99 Don’t know
Employee Health Programs
This section is about [your company’s] health programs. These are programs that the organization offers, or contracts with a vendor to offer to employees. The questions will be about programs for tobacco cessation and physical activity.
48. / Does [your company] provide an employee telephone tobacco cessation counseling program, or quitline? This does not include state-sponsored or other free quitline programs.1Yes 0No 0 Don’t Know
If yes, go to #48a. If no or don’t know, go to #51.
48a. / Is the program or quitline provided by your insurer or an outside vendor?
1 Insurer 2 Outside vendor
48b. / How many employees have access to the tobacco cessation program?
1 0-24%2 25-49%3 50-74%4 75% or more
48c. / (If provided by an outside vendor) What services did the vendor provide?
WRITE IN:
48d. / Over the past 6 months, how much did you pay for this service? ______
Yes / No
49. / Does the telephone counseling service provide nicotine replacement therapy? / 1 / 0
If yes, go to #50. If no, go to #51.
Yes / No
50. / Is there any out-of-pocket expense for the nicotine replacement therapy? / 1 / 0
Yes / No
51. / In the past six months, has [your company] organized or sponsored an employee physical activity program? (This includes long-term efforts to organize employees to exercise regularly. Examples are a long-term pedometer program, Active for Life, training programs for a race, etc.) / 1 / 0
If yes, go to #51a. If no, go to #57.
51a / Is the program provided by your insurer, an outside vendor, or exclusively through[your company]?
1 Insurer 2 Outside vendor 3 Company
51b. / How many employees have access to the program?
1 0-24%2 25-49%3 50-74%4 75% or more
51c. / (If provided by an outside vendor) What services did the vendor provide?
WRITE IN
51d. / Over the past 6 months, how much did you pay for theseservices? ______
52. / How many months out of the year does the program run?_____months per year
Yes / No
53. / Does the program allow participants to choose their own activities? Examples might be walking groups or exercising at a gym. / 1 / 0
Yes / No
54. / Does the program encourage participants to set their own physical activity goals? / 1 / 0
Yes / No
55. / Is the program group-based? Group-based means that employees were on teams or did training in groups. / 1 / 0
Yes / No
56. / Does the program offer incentives to participate? Incentives include cash and non-cash prizes. / 1 / 0
Yes / No
57. / In the past six months, has your company organized or sponsored a weight control or healthy eating program? / 1 / 0
If yes, ask #58. If no, go to #62.
58. / Is the program provided by your insurer, an outside vendor, or exclusively through[your company]?
1 Insurer 2 Outside vendor 3 Company
If yes to “company,” ask #58a. If no, go to #59.
58a. / What type of weight control or healthy eating program did the company organize (fill in the blank):______.
58b. / How many employees have access to the program?
1 0-24%2 25-49%3 50-74%4 75% or more
58c. / (If provided by an outside vendor) What services did the vendor provide?
58d. / Over the past 6 months, how much did you pay for theseservices? ______
Yes / No
59. / Does the program involve multiple components, such as self-help materials, information about goal setting and behavior change, and physical activity and dietary intake recommendations? / 1 / 0
Yes / No
60. / Does the program offer incentives to participate? Incentives include cash and non-cash prizes. / 1 / 0
Yes / No
61. / Does your company evaluate or receive evaluation of the program’s effects, such as pounds lost per person? / 1 / 0
62. / How easy or difficult is it to offer these types of programs at [your company]?
5 Very easy
4 Easy
3 Neither easy nor difficult
2 Difficult
1 Very difficult
0 Not possible (for example, this is a site, and headquarters makes all policy-related decisions)
99 Don’t know
Communication
This section is about health promotion and communication. By this I mean [your company’s] efforts to communicate with employees specifically about health, health behaviors, or chronic disease prevention. This could be anything from a newsletter or email to an organized campaign or group event. These are communications outside of health insurance open enrollment periods or insurance provider communications.
Yes / No63. / Does [your company] promoteany type of tobacco cessation quitline (for example, the free NCI quitline or state-sponsored quitline, or one provided through your insurer) to your employees? / 1 / 0
If yes, go to #63a. If no, go to #64.
63a. / What methods do you use to promote the quitline?
1 Bulletin boards
2 Poster
3 Postcard
4 Newsletters
5 Payroll stuffers
6 Mail to employees’ home / 7 Website
8 Email messages
9 Meetings
10 Fax Referral
11 Lunch & Learn
12 Other
63b. / About how many times per year do you promote the quitline? / ______
times/yr
Yes / No
64. / Does [your company] promote any other tobacco cessation information or resources to your employees? / 1 / 0
If yes, go to #64a. If no, go to #65.
64a. / What methods do you use to promote this information?
1 Bulletin boards
2 Poster
3 Postcard
4 Newsletters
5 Payroll stuffers / 6 Mail to employees’ home
7 Website
8 Email messages
9 Meetings
10 Lunch & Learn 11 Other
64b. / About how many times per year do you send this information to your employees? / ______
times/yr
Yes / No
65. / Does [your company] communicate with employees about drinking healthy beverages (for example, drinking more water or drinking less soda and other sugary beverages)? / 1 / 0
If yes, go to #66. If not, go to #68.
66. / What methods do you use to provide this information?
1 Bulletin boards
2 Poster
3 Postcard
4 Newsletters
5 Payroll stuffers / 6 Mail to employees’ home
7 Website
8 Email messages
9 Meetings
10 Lunch & Learn
11 Other
67. / About how many times per year do you give this information to your employees? / ______
times/yr
68. / Does [your company] communicate with employees about healthy eating (for example, five or more servings of fruits and vegetables per day, or lowering fat intake)? / 1 / 0
If yes, go to #68a. If no, go to #69.
68a. / What methods do you use to provide this information?
1 Bulletin boards
2 Poster
3 Postcard
4 Newsletters
5 Payroll stuffers / 6 Mail to employees’ home
7 Website
8 Email messages
9 Meetings
10 Lunch & Learn
11 Other
68b. / About how many times per year do you give this information to your employees? / ______
times/yr
Yes / No
69. / Does [your company] communicate with employees about physical activity (for example, getting at least 30 minutes of physical activity most days of the week, promoting on-site facilities or worksite programs, etc.)? / 1 / 0
If yes, go to #69a. If no, go to #70
69a. / What methods do you use to provide this information?
1 Bulletin boards
2 Poster
3 Postcard
4 Newsletters
5 Payroll stuffers / 6 Mail to employees’ home
7 Website
8 Email messages
9 Meetings
10 Lunch & Learn
11 Other
69b. / About how many times per year do you give this information to your employees? / ______
times/yr
Yes / No
70. / Does [your company] actively promote nearby physical activity resources, such as walking trails and bike routes? / 1 / 0
Yes / No
70a. / Does [your company] post “take the stairs” signs near elevators and stairwells? N/A / 1 / 0
Yes / No
71. / Does [your company] promote the WA-state breast, cervical and colon cancer program to your employees?(If further clarification needed: This program provides free cancer screening for men and women who have low incomes and lack insurance) / 1 / 0
If yes, go to #71a. If no, go to #72
71a. / What methods do you use to promote this program?
1 Bulletin boards
2 Poster
3 Postcard
4 Newsletters
5 Payroll stuffers / 6 Mail to employees’ home
7 Website
8 Email messages
9 Meetings
10 Lunch & Learn
11 Other
71b. / About how many times per year do you promote these programs? _____ times/yr
Yes / No
72. / Does [your company] communicate with employees about cancer screening guidelines (for example, breast, cervical, or colon cancer screening recommendations)? / 1 / 0
If yes, go to #72a. If no, go to #73.
72a. / What methods do you use to provide this information?
1 Bulletin boards
2 Poster
3 Postcard
4 Newsletters
5 Payroll stuffers / 6 Mail to employees’ home
7 Website
8 Email messages
9 Meetings
10 Lunch & Learn
11 Other
72b. / About how many times per year do you give this information to your employees? / ______
times/yr
Yes / No
73. / Does [your company]communicate with employees about other health-related topics? / 1 / 0
73a. / What other topics does [your company]communicate about?
1 Depression
2 Stress
3 Substance Abuse
4 Worksite Safety
5 Other______
74. / Over the past year, how much money did you spend on printing materials for health promotion communications? (i.e. posters, payroll stuffers, newsletters)
______
75. / In an average week, how much time do you currently spend on managing all wellness activities, including wellness policies, programs, and communications?
1 Less than 30 minutes
2 30-59 minutes
3 60-89 minutes
4 90 minutes-119 minutes
5 2 hours – 149 minutes
6 150 minutes – 3 hours
7 More than 3 Hours
76. / Is there anyone else who spends time on wellness activities? (Does not include wellness committee) This would be someone other than you or the staff member referred to earlier with wellness or health promotion responsibilities. (If Yes, ask 77a-c. If No, skip to Thank You)
76a. If yes, how much time per week?
1 Less than 30 minutes
2 30-59 minutes
3 60-89 minutes
4 90 minutes-119 minutes
5 2 hours – 149 minutes
6 150 minutes – 3 hours
7 More than 3 Hours / Yes1 / No
0
Thank you for participating in our survey!