Workwell Partnership Grant Application

WORKWELL PARTNERSHIP GRANT APPLICATION

Proposal due February 9, 2018

TO PROMOTE HEALTHY LIFESTYLES BY PREVENTING,
REDUCING AND MANAGING CHRONIC DISEASE THROUGH
WORKPLACE ENVIRONMENT AND POLICY CHANGE

Name of Workplace:

Title of Project:

Mailing Address:

City:

Zip Code:

Phone Number:

Contact Person:

Title:

Email Address:

STATEMENT OF NEED

Provide a brief description of the workplace, length of wellness program and sustainability if available, and why the funding is needed for the workplace (limit one page).

WORKWELL PLAN

You will need a means of measuring whether or not changing the policy/environmental barrier and interventions you chose had any impact on preventing, reducing and managing chronic disease. In order to do this, it will be necessary to develop clear, time-oriented and measurable objectives.

An objective reflects changes in knowledge, attitudes or behaviors. This objective should state the change you hope will occur by altering a policy or environmental barrier. For example, by improving a walking path near your facility you hope that more people will use the path and increase their physical activity as a result of this environmental change.

The activities are considered the means to accomplish the objective. They are the big steps necessary to ensure that the change you are anticipating actually occurs. These should also be time-oriented, specific and measurable. Please be sure to turn in each quarter of your WORKWELL Plan.

The WorkWell grant requires at least one employee to attend the 2018 WorkWell summit. The event will take place in quarter two.

APPLICATION SUBMISSION

PLEASE submit your completed application by 5 p.m. on Friday, February 9, 2018

Submit via mail or email to:

Enid Weiss

Workplace Wellness Coordinator

Black Hills Special Services

818 S. Broadway #110

Watertown, SD 57201

Phone: (605) 878-0314

Email:

WELLNESS RESOURCES

The Office of Chronic Disease Prevention and Health Promotion have developed a simple to use toolkit for workplaces (goodandhealthysd.org/workplaces)to utilizewhen implementing a wellness program. It contains the key steps it takes to organize a successful wellness program. Inside the toolkit you will find resources that will guide you in creating the WorkWell plan and the evaluation.

Additional resources for other project ideas can be found under the following programs:

Cancer

AWC!, GetScreendSD, SD Cancer Coalition, and Cancer Registry landing page
Centers for Disease Control
American Cancer Society

Diabetes

South Dakota Department of Health-Diabetes Prevention and Control Program
National CDC Diabetes Prevention Program
Diabetes Prevention Programs in South Dakota
South Dakota DiabetesCoalition

Heart Disease and Stroke

SD Department of Health DiseaseStrokePrevention
Million Hearts
American Heart Association

Nutrition

Healthy South Dakota
MunchCode
Choose MyPlate
Fruits & Veggies More Matters
Breastfeeding: sdwic.orghealthysd.gov/breastfeeding

Physical Activity

Healthy South Dakota
2008 Physical Activity Guidelines for Americans
Steps to Wellness CDC toolkit

Tobacco

Be Tobacco FreeSouth Dakota
South Dakota QuitLine1-866-SD-QUITS
SD Department of Health Tobacco Control Program
CDC Smoking and Tobacco Use

Oral Health

South DakotaDepartment of Health Oral Health Program
MayoClinic
Drink Up - Partnership for a Healthier America

Model Policies

Worksite UV Protection Model Policy

This Worksite UV Protection Model Policy provides a framework to encourage and support UV protection and is designed to assist safety personnel as they create sun protection guidelines for their worksite setting.

Tobacco-Free Business Model Policy

The Tobacco-Free Business Model Policy provides a frameworkto protect and promote the health and well-being of business employees and visitors. The use of tobacco products by employees or visitors compromises the mission ofproviding a safe and healthy place to conduct business.

Worksite Physical Activity Model Policy

The Worksite Physical Activity Model Policy provides a framework to encourage and support employee physical activity and create a worksite culture that supports health and total well-being.

Healthier Foods and Beverages at Meetings and Presentations Model Policy

The Healthier Foods and Beverages at Meetings and Presentations Model Policy is designed to help businesses offer healthier food and drink options at allbusiness sponsored and/or coordinated meetings andpresentations.

Healthier Vending and Snack Bar Model Policy

TheHealthier Vending and Snack Bar Model Policy helps businessesincorporate healthier snack food and drink items in vending machines and snack bars. The policy is based on the South Dakota Healthier Vending and Snack Bar Standards. The policy and standards can be found in the HealthierVending & Snack Bar Toolkit.

Breastfeeding Support Model Policy

The Breastfeeding Support Model Policy was developed to provide businesses with guidelines and guidance on ways to support breastfeeding employees including information on the Patient Protection and Affordable Care Act which requires employers (with ≥ 50 employees) to provide nursing mothers with:

reasonable break time to express breast milk for one year after her child’s birth each time such employee has the need to express breast milk; and
a private space, other than a bathroom, that is shielded from view and free from intrusion of others, to express breast milk.

Worksite Cancer Screening Model Policy

The Worksite Cancer Screening Model Policy was developed to increase cancer screenings in worksites. Cancer was the second leading cause of death in South Dakota in 2014, with 4,498 cancer cases diagnosed and 1,679 deaths. Recommended cancer screening tests may find breast, cervical and colorectal cancers early, when treatment is likely to work best. The South Dakota Department of Health (SDDOH) is collaborating with many partners to increase screening for these cancers.

WORKWELL Goal:
Objective:
Activity:
Timeline:
Partners:
Committee Member Tasks:
Marketing Strategies:
BUDGET:
DESCRIPTION:
COST:
JUSTIFICATION: / .

Quarter 1: May 1, 2018– July 31, 2018 WORKWELL Plan

WORKWELL Goal:
Objective:
Activity:
Timeline:
Partners:
Committee Member Tasks:
Marketing Strategies:
BUDGET:
DESCRIPTION:
COST:
JUSTIFICATION:
WorkWell Partnership Summit: / Yes, an employee will be attending during this quarter. ______
Employee(s) Name:______

Quarter 2: August 1,2018-October 31, 2018 WORKWELL Plan

Quarter 3: November 1, 2018 -January 30, 2019WORKWELL Plan

WORKWELL Goal:
Objective:
Activity:
Timeline:
Partners:
Committee Member Tasks:
Marketing Strategies:
BUDGET:
DESCRIPTION:
COST:
JUSTIFICATION:

Quarter 4: February 1, 2019 -May 30, 2019 WORKWELL Plan

WORKWELL Goal:
Objective:
Activity:
Timeline:
Partners:
Committee Member Tasks:
Marketing Strategies:
BUDGET:
DESCRIPTION:
COST:
JUSTIFICATION:
WORKWELL Goal: / Employees will become more knowledgeable through health education classesto enhance knowledge of chronic disease prevention.
Objective: / During the months of May, June and July education classes will be held in the health areas of nutrition, cancer and diabetes to provide employees with how to make healthy lifestyle choices and changes. Provide employees with fruit choices. Employees can purchase items at cost to build and establish a fruit fund for the worksite.
Activity: / Provide weekly nutrition, cancer and diabetes lunch and learns for employees.
Timeline: / Quarter 1: May 1, 2018 – July 31, 2018
Partners: / Avera Cancer Department
Hy-VeeDietician
SD Department of Health
Committee Member Tasks: / All Committee: Plan for experts, discuss each topic area and create calendar.
Jon: Schedule room location Bill: Make reminder calls or emails to presenter
Jane: Email weekly lunch and learn to employees All Committee: Create evaluation
Marketing Strategies: / Email scheduled sessions to employees and hang calendars around the office.
BUDGET:
DESCRIPTION: / Our wellness committee has planned to provide the employees of our workplace with weekly lunch and learns that are informational around nutrition, cancer and diabetes.
COST: / $350.00
JUSTIFICATION: / By bringing in experts in the nutrition, cancer and diabetes field, they will be able to provide information and teach our workplace the important roles each of these areas play in our health and how each can be used to prevent, reduce and manage chronic disease.

Quarter 1: May 1, 2018 – July 31, 2018 WORKWELL Plan

SAMPLE WORKWELL PLAN

Develop a budget and justification that follows your project objectives. Funds should support preventing, reducing and managing chronic disease through workplace environment and policy change. Below are sample budgets with operating expenses that are consistent with proposed objectives and planned activities. This will help you plan your budgetary needs and allow the workgroup to search for resources based on funding needs. Keep in mind that this is a sample and you may want to plan your quarter out differently. It is also a good idea to focus on Health Observances during the month they are recognized.

Sample Budget and Justification

Description / Cost / Justification
May
Dietician- stipend 4- 1 hour sessions
@ $25/hour
Healthy fruit bar-$50
/ $100.00
$50
/ Week 1: Educate employees on nutrition, heart-healthy diets and weight management.
Week 2: Educate employees on how to make healthier choices and reading food labels.
Week 3: Create a one week menu that is simple and healthy.
Week 4: Hold a healthy lunch using recent learned education sessions.
Provide employees with fruit choices. Employees can purchase items at cost to build and establish a fruit fund for the worksite.

June

Cancer- stipend 4- 1 hour sessions

@ $25/hour

/ $100.00 / Week 1: Educate employees on the different types of cancer.
Week 2: Educate employees on colorectal cancer.
Week 3: Educate women employees on cervical and breast cancer.
Week 4: Educate men on prostate cancer.
July
Diabetes- stipend 4- 1 hour sessions @ $25/hour / $100.00 / Week 1: Screening for Diabetes-Free screening for diabetes
Week 2: Diabetes Education-Handouts
Week 3: Pre-diabetes-Give away a gift card to local gym
Week 4: Nutrition for Diabetes- Cookbooks
TOTAL / $350.00

Quarter 1: May 1, 2018 – July 31, 2018

WORKWELL Budget and Justification

Description / Cost / Justification
TOTAL

Quarter 2: August 1, 2018 – November 30, 2018

WORKWELL Budget and Justification

Description / Cost / Justification
TOTAL

Quarter 3: December 1, 2018 – February 28, 2019

WORKWELL Budget and Justification

Description / Cost / Justification
TOTAL

Quarter 4: February 1, 2019 – April 30, 2019

WORKWELL Budget and Justification

Description / Cost / Justification
TOTAL

Evaluation

As part of the WorkWell application process, please submit an evaluation that is created around the four quarters of your WorkWell Plan.This evaluation is to be given to your employees at the end of each quarter in order to evaluate the effectiveness of the program. Evaluations must be at least three - five questions in length. Provided below is a sample evaluation and a blank evaluation for use. Each quarter may require a different evaluation. Be sure to label the evaluation with the correct quarter. During the grant period, evaluations will be required to be submitted with employee’s results.

Sample Evaluation

I was able to attend the educational sessions.

/ 1-4sessions 5-8 sessions 9-12 sessions

Sessions offered were relevant and enhanced my knowledge in chronic disease prevention.

/ Yes No

I have made a lifestyle change because of one or more of the sessions. Please explain:

/ Yes No
Explain:

Would you attend more education sessions and if so, what would be of interest?

/ Yes No
Explain:

Other (please specify)

Quarter 1: May 1, 2018 – July 31, 2018 WORKWELL Evaluation

Evaluation

1. / Yes No
2. / Yes No
3. / Yes No
4. / Yes No
5. / Yes No

Quarter 2: August 1, 2018 – October 31, 2018 WORKWELL Evaluation

Evaluation

1. / Yes No
2. / Yes No
3. / Yes No
4. / Yes No
5. / Yes No

Quarter 3: November 1, 2018 – January 31, 2019 WORKWELL Evaluation

Evaluation

1. / Yes No
2. / Yes No
3. / Yes No
4. / Yes No
5. / Yes No

Quarter 4: February 1, 2019 – April 30, 2019 WORKWELL Evaluation

Evaluation

1. / Yes No
2. / Yes No
3. / Yes No
4. / Yes No
5. / Yes No

Webinar and Summit Evaluation

JulyWebinar / Yes No
October Webinar / Yes No
JanuaryWebinar / Yes No
AprilWebinar / Yes No
Summit: The 2018 WorkWell Partnership Summit was attended by our workplace employee(s). / Yes No
Name(s): ______

DateAttended