Work healthy Georgia : live healthy Georgia

Georgia Work Healthy

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Wo r k H e a l t h y G e o r g i a To o l k i t
"I already have an established worksite wellness program. How can I use this toolkit?"
Read the following criteria and turn to the corresponding section. I If you are thinking about implementing a worksite wellness program and you are interested in
the benefits of worksite wellness, turn to Section I. I If you already know the benefits associated with implementing a comprehensive worksite
wellness program and you are ready to get started, turn to Section II. I If you already have an established worksite wellness committee and are looking for
components to include in your worksite wellness program, turn to Section III. I If you are looking for activities to implement related to nutrition, physical activity, being
smoke-free, psychological health and screenings, turn to Section VI. I If you are interested in targeting high-risk employees, turn to Section V. I If you are searching for tools and resources to implement in your worksite, turn to section VI.
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Ta b l e o f C o n t e n t s

PREFACE

I Introduction

iv

I Purpose

v

I Acknowledgements

vi

SECTION ONE

BEFORE YOU START

1

Is it Time for Worksite Wellness?

2

Worksite Health Initiative

3

Why Invest in Worksite Wellness?

7

Worksite Wellness Program Costs and Benefits

9

Choosing the Program That's Right for You

10

Preparing for Your Worksite Wellness Program

12

Section One Resources

14

SECTION TWO

GETTING STARTED

15

Conduct Assessments

16

Prepare for Implementation

18

Implement Your Program and Maintain Employee Interest

21

Monitor and Evaluate Your Results

23

Section Two Resources

25

SECTION THREE

DESIGNING YOUR PROGRAM - A COMPREHENSIVE APPROACH

27

Designing and Choosing Program Components

28

Environmental Changes

29

Policy Changes

30

Individual Behavior Change Programs

31

Awareness and Communication Vehicles

32

Formal and Informal Leadership Structures

33

Social Support Networks

34

Section Three Resources

35

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Ta b l e o f C o n t e n t s

SECTION FOUR

FOCUS AREAS FOR ALL EMPLOYEES

37

Eat Healthy

38

Be Active

41

Be Smoke Free

47

Tobacco Free Policy Implementation Plan

51

Get Checked

53

Be Positive

56

Section Four Resources

59

SECTION FIVE

FOCUS AREAS FOR HIGH-RISK EMPLOYEES

61

Risk Reduction

62

Chronic Diseases

63

Emergency Response

67

Section Five Resources

69

SECTION SIX

SAMPLES, TOOLS AND OTHER RESOURCES

71

Georgia Wellness Assessment Tool

72

Lactation Support for Georgia Employers

82

Program Plan

88

Sample Budget

89

Sample Program Evaluation Survey

91

Needs and Interest Survey

92

Health Behavior Survey

94

Sample Health Risk Assessment

97

Screening Guidelines for Women and Men

105

GSA Wellness and Sustainability Focus Areas

108

Targeting Employers Throughout Georgia

110

Establishing A Worksite Farmer's Market

112

Worksite Wellness for School Employee

116

Sample Signage

126

Sample Policies

127

Lactation Policy

127

Model Smokefree Policy

129

Sample Health Foods Policy

131

Healthy Eating/Meeting Policy Implementation Plan (need guidelines for meetings?)

132

Healthy Worksite Foods Policy

to come?

Additional Online Resources

134

References

138

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Preface
INTRODUCTION
Every year, businesses in the United States spend billions of dollars on the health care of their employees. Many of these healthcare dollars are spent on the treatment of chronic diseases such as hypertension, diabetes, heart disease, and obesity, all of which are influenced by lifestyle behaviors like unhealthy eating, physical inactivity, and tobacco use. And, all of which are largely preventable by changes in these behaviors.
In 2011, employers estimated the average increase in health care costs to be 7.4%, with estimates ranging from no increase to a 15% increase.1 For 2012, employers are estimating a similar increase of 7.2%.1 In addition to the financial burden of these diseases, lost or decreased productivity is a major concern and source of revenue loss. For employers, poor employee health leads to lower productivity, lower morale, and a higher rate of insurance claims. Yet, for employees, the demands of job and family pose a significant challenge to maintaining good individual health.
Employers who hope to make significant progress toward reversing these trends need to reach employees where they spend most of their day: at work. Accordingly, the Georgia Department of Public Health believes that a healthy worksite is an essential component of reducing the growing rate of preventable chronic diseases in Georgia and the nation and has developed the Work Healthy Georgia toolkit to support employers in developing meaningful health promotion programs in the work place!
Worksite health promotion programs are a convenient and effective option for encouraging employees to make lifestyle changes in areas that, if left unattended, will ultimately affect the company's bottom line. Research continues to show a return on investment to employers who invest money in the health of their employees by instituting comprehensive health promotion and risk reduction programs.2 And, many employers view such programs as outstanding recruitment and retention tools.
The Work Healthy Georgia toolkit has been developed for all worksites regardless of size or industry type and contains resources, sample policies, and program ideas to help you initiate or advance your worksite wellness initiatives regardless of where you may be starting with your worksite wellness program.
Perhaps your organization has a wellness program, but you're not receiving the results you expected...The ideas and best practices in this toolkit can help you adjust your existing activities or add new ones to help you achieve your goal of a healthier work force.
Or, perhaps your company does not already have a wellness program in place... The Work Healthy Georgia toolkit will help you go from start to success using program components that are most appropriate for your work place.
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Preface
PURPOSE
While it is certainly not designed to be the final authority, the Work Healthy Georgia toolkit provides an array of strategies and action steps that can be built into your overall program efforts at any level. It has been shown time and again: a worksite-based health promotion program can and does - support changes that lead to healthier behaviors, and healthier employees! We encourage you to use the resources and program ideas found in this toolkit to start your employees on the path to wellness, and reap benefits that will last a lifetime. We welcome your ideas, comments, and success stories and have provided a feedback form at the end of this toolkit for your convenience. We look forward to hearing from you!
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Preface

Content and Development: Melodi Ford, Verizon Wireless Pat Jones Southeast Health District 9-2 Anne Wheeler

ACKNOWLEDGMENTS

We would like to thank all of the following organizations and individuals, for their contributions:
Georgia Department of Public Health Kiley Morgan Beatrice Olanihun Andrea Wimbush Keith Mitchell Michael Bryan Omar Guessous Sonya Crutchfield Chad Neilsen Frank Lawrence Cheryl Scales Marcia Hunter Members of the "Georgia's Nutrition and Physical Activity Initiative Worksite Workgroup" Georgia Cardiovascular Health Initiative Diane Roberts Ayers Ramona Bennett Richard Christiana Edna Davis Jon Ducote Erin Fitzgerald Mara Galic Jean Gearing Sara Kuester, Centers for Disease Control and Prevention Jianglan White Constella Group Health Navigators, LLC. Health Promotion and Disease Prevention Programs, Georgia Department of Public Health Georgia Breastfeeding Coalition SouthEastern Lactation Consultant Association Healthy Maine Partnership Southwest Health District 8-2 Albany "Hooked on Health" Initiative Wellness Council of America

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Section One
BEFORE YOU START
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IS IT TIME FOR WORKSITE WELLNESS?
Many business leaders may say that they value the health of their employees and think that worksite wellness is a great idea. However, when faced with the decision to implement a wellness program, they often respond, "It's not a company priority at this time."
If you feel the same way, consider the brief questionnaire below.

Our company wants: Strongly Disagree

Healthier employees.

J

To improve employee

productivity and reduce

J

absenteeism.

Disagree Neutral Agree

J

J

J

J

J

J

To reduce the cost of

J

health benefits/health

care.

J

J

J

To attract and

J

retain employees.

To be a positive force

for improving

J

community health.

To be competitive with

J

other businesses.

J

J

J

J

J

J

J

J

J

Strongly Agree
J J J
J J J

If you responded "Agree" or "Strongly Agree" to any of the statements above, then worksite wellness is a priority for your company. The health of your employees is strongly tied to the success of your company. No matter what size, industry, or geographic area, businesses whose employees are healthier experience increased productivity and reduced health care costs, and are better able to compete in the marketplace.

For more information on the prevalence of diseases and risk factors in Georgia, go to: http://health.state.ga.us/publications/reports.asp

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GEORGIA DEPARTMENT OF PUBLIC HEALTH WORKSITE HEALTH INITIATIVE
Why Worksite Wellness Programming The prevalence of adult obesity in Georgia is at an all-time high. Nearly 28.7% of Georgia adults are obese, and 34.9 % overweight (BRFSS, 2011). These estimates have nearly doubled over the past 25 years and continue to rise. This burden affects all individuals, regardless of age, race, gender, income, or education level. Physical activity levels among Georgia adults is also low, only 20.7% of adults meet both the aerobic and muscular stretching components of federal physical activity recommendations. Furthermore, only 28% of Georgia adults meet recommendations for fruit and vegetable consumption (BRFSS, 2011).
The obesity epidemic in the state of Georgia is due to a variety of factors including: increased consumption of energy-dense foods, decreased fruit and vegetable consumption, decreased physical activity, and increase sedentary behavior. These factors are all present when examining adult worksites. The increase reliance on unhealthy vending machine options and the loss of cafeterias in many worksites due to tough economic times, the rise in health insurance, and the general increase in sedentary jobs have played a contributing role (Escoffery, Kegler, Alcantara, Wilson, & Glanz, 2011). Data demonstrates that employees spend an average of 50 hours a week at work. Employees also eat about one-third of their meals during the workday. Georgia Department of Public Health (GDPH) interventions aimed at increasing healthy behaviors at the workplace have had positive results and have identified strategies that could be useful for new worksite health initiatives. Without workplace health initiatives and interventions, there will be little progress in obtaining a healthier workforce and decreasing the prevalence of obesity in the state of Georgia.
Program Design The Georgia Department of Public Health's worksite wellness program is designed to enrich GDPH's employee's physical, mental, emotional, occupational, and spiritual wellbeing. A major goal of the program is to make the work environment more supportive of positive health behaviors for its employees and thereby reduce their risk of developing chronic diseases. To assist employees in adopting healthier behaviors- including healthy eating, physical activity, and tobacco cessation. The GDPH worksite wellness program primarily addresses modifiable chronic disease risk factors such as physical activity, nutrition, blood pressure, weight, and diabetes management.
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History "Health Matters/DHR on the MOVE" "Health Matters/DHR on the MOVE", a worksite wellness initiative for approximately 2,500 employees working within the Georgia Department of Human Resources, was initiated in 2002. Health Matters began with the development of a pilot, Health Matters Challenge, in June of 2002 for employees in the Division of Public Health. The goal of the 2-day challenge was to assist employees in identifying and implementing positive health changes. Employees were able to test their level of personal fitness, participate in exercise classes, obtain a bone density screening, and be counseled individually about completing the challenge. The Challenge was repeated in October 2002, June 2003, and July 2004. Baseline data on all the assessments (such as Body Mass Index, fitness tests, and bone density) were collected on employees who participated in the launch of the Challenge and for subsequent years. In addition, an informal worksite wellness committee was formed. The committee was comprised of staff from the Health Promotion and Disease Prevention Program (formerly Chronic Disease Prevention and Health Promotion Branch), Maternal and Child Health (formerly Family Health Branch), and with leadership from the HPDPP's Cardiovascular Health Worksite Wellness Coordinator.
In order to enhance the nutrition and physical activity component of Health Matters, the Health Matters worksite wellness committee recognized the need to offer regular activities related to healthy eating and physical activity, in addition to the Health Matters Challenge, in order to foster sustained behavior change among employees. The committee began planning for the pilot by conducting a needs assessment during the July 2004 Health Matters Challenge and conducted an additional survey in December of 2004. The results of the surveys were analyzed and formed the basis of the Health Matters six-week pilot project, DHR on the Move.
The DHR on the Move pilot was launched in January 2005. The goal of the project was to improve employee wellness and to create a worksite environment that promoted healthful eating and physical activity. The objectives of the pilot were to increase levels of physical activity, improve healthy eating habits (such as increase fruit and vegetable consumption), and increase the number of environmental supports for healthy eating and physical activity within the 2 Peachtree Street building location. The pilot project directly targeted the three hundred and fifteen (315) employees working in select branches within the Division of Public Health, specifically the Women, Infants, and Children Program (WIC), Maternal and Child Health, Health Promotion and Disease Prevention, and Epidemiology. These program areas were chosen specifically because the employees work in the area of health or have programs that address nutrition and physical activity, thus starting with an audience that is already aware of the importance of healthy eating and being physically active for overall health.
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Health Matters/DHR on the Move

Strategy
Walking Groups
Weekly Lunch and Learns on Nutrition and Physical Activity Classes will incorporate

Barrier
(How does the strategy link to barriers identified)

Incentive
(How does the strategy link to the incentives identified)

Lack of shower and change facilities: employees who participate may not need to change or use shower facilities compared to participating in an aerobics class.
Buddy system will be incorporated to provide social support

Pedometers will be provided as incentives to participate (signing up for DHR on the Move) and track steps
DHR on the Move challenges between branches
Management to provide time off of work.

concepts of goal setting, address the factors such as eating on a healthy budget, cost of healthy choices, how to be physically active on your break and lunch hour, and selfefficacy. Recipes

Coupons for fruits and vegetables Measuring Cups Other promotional items

Worksite Environment
Healthy Vending Choices Shower facilities Promote on-site R&R
produce store

Healthy choices that are lowcost will be offered in vending machines
Encourage management support through team meetings

Existing healthy choices will be labeled in vending machines
Promote healthy choices offer at R&R produce stand

On-site Exercise Classes
Distributing calendar of events in building and neighboring facilities

Encourage management support Calendar of exercise classes

of these classes through team

currently provided by employees

meetings

Marketing Health
Messages DHR on the Move website Weekly emails

|Promotes availability of Lunch and Learns, exercise facilities as
well as incentives to participate.

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The outcomes achieved by the DHR "Health Matters/DHR on the Move" Worksite Wellness Initiative included: Administering Fit-checks to employees to develop baseline health data for program development and comparison Offering periodic group exercise classes for employees: such as yoga, tai chi, and kickboxing as well as relaxation sessions for stress management Providing pedometers, stretch bands, donated incentive items, and resource materials that may be applied at the worksite and daily lifestyle scenarios. Establishing several environmental changes and supports such as a lactation room, healthier eating options in vending machines, point of decision prompts for stairwell usage, and ongoing program support of free exercise classes and onsite fruit and vegetable farmer's market. Establishing active walking groups with team leaders on each participating floor.
Summary "Health Matters/DHR on the Move" primarily targeted employees within the 2 Peachtree building. In August of 2012, the Georgia Department of Public Health, Office of the Chief of Staff, hired a full-time worksite wellness coordinator to focus on Public Health staff located at 2 Peachtree Street, Pryor Street, and the PH labs. Staff within Health Promotion and Disease Prevention (HPDP) supported this effort by creating a five year worksite wellness plan for the Commissioner that focused on evidence-based interventions recommended by the Centers for Disease Control and Prevention. This plan included promoting stair-well use, creating physical activity and tobacco free campus policies, increasing the amount of healthy food options, and opening an on-site fitness center. Susanne Koch currently serves as the worksite wellness coordinator for DPH. The HPDP worksite wellness coordinator has always supported the efforts of the DPH worksite wellness coordinator, working collaboratively to increase the number of healthy employees.
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WHY INVEST IN WORKSITE WELLNESS?
The financial demands of running a business are tremendous. Not only do employers have to keep profitability in mind, they must also make the best use of staff time which is often challenging, at best! So, why is it important to invest in worksite wellness? Take a look at these startling facts:
Five major chronic diseases cause more than two-thirds of deaths in the United States: heart disease, cancer, stroke, chronic obstructive pulmonary disease (COPD), and diabetes.
About 75% of health care costs each year are attributable to chronic preventable diseases. More than 125 million Americans are living with these chronic diseases and 1 in 10 experiences major limitations in activity as a result.
Chronic diseases account for $3 of every $4 spent on healthcare. That's nearly $7,900 for every American with a chronic disease.2
As the alarm bell sounds on the national stage, the trend is equally - and dangerously - urgent at home. In 2009 Georgia personal health care spending totaled $5,467 per capita.3 Employers are not exempt from this trend, as evidenced by the skyrocketing employee benefit costs that directly impact employers' bottom lines. The majority of these health care costs are borne by the employer in the form of employer contributions to insurance premiums - which continue to rise with no apparent end in sight. As a result, many employers are being forced to reduce health benefits coverage or eliminate it altogether. Yet, while loss of employer sponsorship is certainly a factor, a significant portion of the health benefits decline rests directly on the shoulders of employee behaviors and lifestyle choices. Nearly $250 billion is spent each year on health care costs related to lifestyle choices, including unhealthy eating habits, tobacco use, and sedentary lifestyles.4 In Georgia, only 2 in 5 adults are regularly physically active. Activity levels have been on the decline since 1996 amounting to 5,543 deaths, 29,844 hospitalizations, and $477 million in hospital charges.5 Additionally, 1 in 4 Georgians uses tobacco, which leads to more than 11,000 deaths per year and more than 190,000 years of life lost prematurely. Further, tobacco users utilize health care 50% more than non-tobacco users, amounting to $1.8 billion in direct medical costs every year for tobacco-related illness.6
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Along with actual health care costs, on-the-job productivity losses account for a significant portion of the total dollars attributable to common chronic health conditions among employees. Absenteeism (i.e. employees' inability to work due to illness) poses a substantial burden for employers. A national study of 2,000 workers aged 25 to 54 showed that those with an impairment resulting from a chronic disease reported an average of 6.7 workdays lost per month.7 An even more costly, but often overlooked, aspect of employee illness is presenteeism which refers to the lost productivity that occurs when employees come to work but perform poorly due to illness and accounts for an estimated $180 billion a year.8
The good news is that worksite wellness programs can help your organization get on the right track to reversing these trends, creating a win-win outcome for your employees and your company. In fact, employers who conduct wellness programs have documented results like these:9
Average 28% reduction in sick leave absenteeism Average 26% reduction in health costs Average 30% reduction in workers' compensation and disability management claims
costs Average $5.93-to-$1 savings-to-cost ratio The evidence is abundant and the need for programs that encourage employee lifestyle change has never been greater. Whether your goal is to keep all your employees healthy or to identify and assist those who have or are at risk for developing chronic preventable diseases, a worksite wellness program is worth the investment. Starting today, you can begin taking steps to reduce the burden of chronic diseases among your employees and the financial burden on your company. The Work Healthy Georgia toolkit can provide the answers you've been looking for!
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WORKSITE WELLNESS PROGRAM COSTS AND BENEFITS
The costs of an effective worksite wellness program are flexible, and they vary depending on the type of program, size and scale, and the resources available. Choosing the level of investment that's right for your company is entirely up to you. Comprehensive wellness programs are, of course, more expensive. However, the Wellness Council of America estimates a return on investment of $300 to $450 for every $100 to $150 spent per employee, making the comprehensive approach a smart investment. In starting a wellness program, you should consider the following program component costs:
Wellness Program Costs
1. Personnel - The initial costs of starting a worksite wellness program include staff time spent planning and organizing the program. Wellness program staff may include an external contractor, a full- or part-time employee wellness coordinator, or regular staff assigned to the wellness committee.
2. Infrastructure - The dollar amount spent to support your worksite wellness program will depend on how comprehensive and extensive your program will be, as well as the focus and objectives of your program. Costs may include creating safe walking trails or installing bike racks; developing and printing newsletters; providing medical health risk assessments for all employees; or telephonic wellness coaching.
3. Activities - As with your program infrastructure, activity costs will depend on the requirements necessary to carry out the activity (e.g. lunch-and-learns, walking programs, etc.) These may include costs for informational flyers, pedometers, and incentives for participants.
The benefits of a worksite wellness program extend far beyond the direct gains in health cost savings. Dividends that an employer will reap include a healthier and more productive staff, increased employee morale, and improved company culture. Even more important, you will enjoy the satisfaction of knowing that you've made a significant and lasting contribution toward the health of the people in your company.
Wellness Program Benefits
I Return on investment I Increased employee productivity I Reduced health benefits costs and medical claims I Reduced disability claims I Reduced workers compensation claims I Increased employee morale I Decreased employee turnover I Employee retention and recruitment
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CHOOSING THE PROGRAM THAT'S RIGHT FOR YOU
Choosing the most appropriate worksite wellness program for your company depends on a number of factors, including management's expectations for the wellness program, available resources, and employee needs and interests. Most worksite wellness programs fall into one of three categories:
Health promotion programs for all employees
Disease management programs for high-risk employees
Population health management programs

Health Promotion Programs A health promotion program addresses disease prevention among all employees, regardless of risk level, current health status, or any other stratification. These programs are designed to help move employees toward a healthier lifestyle by providing health information and opportunities to engage in healthy behaviors. This type of program is what has been traditionally thought of as a "wellness program". It is activity-based and makes use of a wealth of health education materials. As part of their health promotion efforts, many companies offer fitness and nutrition classes, screenings, health fairs, and lunch-and-learn events. Some worksites also distribute or display health education materials and/or promote health observances like Heart Health Month or World Asthma Day.

Disease Management Programs Unlike health promotion programs, which target all employees, disease management programs are designed to identify high-risk employees and provide them with specific interventions aimed at reducing their risks for specific diseases and conditions. These programs, by definition, focus exclusively on those employees who have developed a disease or its precursor, or are at risk for doing so. Disease management programs help individuals reduce their risk of developing a disease or a related condition by teaching them to monitor and manage their illnesses (self management), or by placing their care under the management of a team of health care providers (case management). Examples of disease management programs are the Diabetes at Work program and the Arthritis Foundation Exercise Program. The table below compares the two types of workplace wellness programs:

Focus

ROI*

Target Audience Other Notes

Health promotion: behavior changes that prevent health issues.
Disease management: monitor and treat specific diseases.

$3 - 6 return on investment (ROI) within 2-3 years
$7 - 10 ROI within 1 year.

All employees

Greater appeal as a recruiting and retention tool.

An estimated 20% of employees, the high risk group, that utilize 80% of health care costs

ROI is lower over time than a prevention approach.

*Return on Investment according to the National Business Group on Health.10
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Population Health Management Programs Like health promotion programs, the population health management approach reaches out to employees throughout the organization, not just those who have a chronic disease or who are at risk for developing one. This approach addresses the entire continuum of employee health risk, from no or low risk through onset of disease, and ensures that no one moves along the continuum toward high risk without appropriate intervention.11 When medical intervention is required, treatment levels may include: 1) disease management, 2) careful monitoring of the individual's health status and adherence to a treatment regimen, 3) modification of treatment as needed, and 4) monitoring of the individual's efforts to make lifestyle and behavior changes. The only variations across risk levels are the amount of care and intensity of effort expended to ensure that individuals are monitored for symptoms and motivated to begin lifestyle modifications and behavior change programs. Utilizing this approach requires implementing inter-linked prevention and risk reduction strategies that have been proven to be effective, science-based, and grounded in best practices of medicine and health promotion. This approach also incorporates changes within the organizational culture to make health and wellness a priority, taking steps to make healthy choices available, and providing resources and incentives to support employees in their efforts to be, and remain, healthy. A variety of incentives may be required to increase participation in these more intensive efforts. Yet, all employees, regardless of risk level, can reap the benefits of routine clinical preventive services, including screenings, early identification of diseases, appropriate immunizations, and referral to the best treatment sources. While the population health management approach is certainly the "gold standard," it is unrealistic to think that most employers will have the time and resources to adopt this strategy at the outset of their efforts. Thus, the Work Healthy Georgia toolkit focuses on helping you get started with the most commonly adopted strategies:
Health promotion programs for all employees Disease management programs for high-risk employees
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PREPARING FOR YOUR WORKSITE WELLNESS PROGRAM Worksite Wellness Committee
Ultimately, the success of your worksite wellness program will depend on reaching every employee in every position in your company. So it's important to establish a broad-based wellness committee or task force to plan, organize, and implement the worksite wellness program. This participatory approach is similar to quality improvement programs that emphasize the need for employees to be detail- and results-oriented and to provide feedback to supervisors and co-workers. The beauty of a broad-based worksite wellness committee is that members can pull representatives from throughout the organization to look at health issues from different perspectives and encourage various employee groups to work together to improve the work environment and the organizational culture so that it supports health and wellness at every level. Forming such a committee will enable you to overcome resource limitations, while crafting interventions that are effective across the entire worksite. Another advantage of the wellness committee approach is that involving employees from all segments of the organization creates buy-in drawing in multiple perspectives to identify aspects of the worksite needing change, to mobilize resources, and implement effective solutions.
Wellness Committee First Steps
Step 1: Gain management leadership support. Leadership involvement and commitment to worksite wellness and the process of change is critical to the success of the program. Provision of incentives to encourage employee participation, as well as changes in company policy, investments in environmental changes or infrastructure, and modifications in health benefits programs require leadership involvement. Step 2: Identify a coordinator. This person will be responsible for organizing meetings and keeping the process moving forward. This person should be organized, motivating, and committed to the process. Step 3: Recruit employees. Pull together employees who can work together across all the levels and sectors of the organization.
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Management Support It is essential to recognize the role of managers in effective worksite wellness programs. Though their attitudes may vary from "wellness champion" to active opposition, their support for and participation in the program is vital they can make or break your program! Perhaps you're reading this Work Healthy Georgia toolkit because your organization's leaders have understood and endorsed the need for a worksite wellness program. If so, congratulations! You're already well on your way. But if garnering management support is your next step, consider presenting the materials in the "Why Invest in Worksite Wellness" section of this toolkit, and gain their approval to survey employees for more specific interests and needs. Be prepared to address potential concerns and present the benefits, both for employees and the company as a whole, of implementing a wellness program.
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SECTION ONE RESOURCES
Wellness Council of America. Healthy, Wealthy, Wise. Available at: http://welcoa.org/freeresources/pdf/healthy_wealthy_wise.zip Hunnicutt, D. (2007). Carefully Crafting Your Organization's Wellness Plan. WELCOA's Absolute Advantage Magazine, 6(7), 4-11. Available at: http://welcoa.org/freeresources/pdf/crafting_your_orgs_wellness_plan.pdf Lynch WB. What is a Healthy Employee Worth? WELCOA's Absolute Advantage Magazine, 2002, 16-19. Available at: http://welcoa.org/freeresources/pdf/healthy_employee_2.pdf Hunnicutt, D. (2007). 10 Secrets of Successful Worksite Wellness Teams. WELCOA's Absolute Advantage Magazine, 6(3), 6-13. Wellness Council of American. Available at: http://welcoa.org/freeresources/pdf/10_secrets.pdf
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Section Two
GETTING STARTED
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TWO
Getting Started
CONDUCT ASSESSMENTS
Before you get started with your worksite wellness program, you need to have a good understanding of where you're starting from! That's why assessments are an integral part of planning any worksite wellness program. You will need to collect information on your company and your employees, the physical location and environment of the worksite, and your available resources. Conducting an assessment has two advantages. First, the assessment will help you identify your needs and the assets you have at your disposal. And second, assessments provide the baseline data against which you can compare future results; that's how you measure progress and a job well done!
Conduct an Environmental Scan Any effective wellness program should aim to create a physical environment that provides employees with multiple opportunities to eat healthy, be physically active, and avoid exposure to tobacco products and second-hand smoke as a part of their workday. As a first step, take a look at your physical workplace environment to see how equipped it is to support these workplace wellness activities. The physical environment includes everything from the quality of the air people breathe to the quantity and quality of the activity-related resources available. Examining the worksite for opportunities to make environmental changes may require a walk-around or a review of your facility. Things to look for in this type of assessment may vary from the availability of a walking trail to a poor ventilation system. While some physical environmental interventions, such as building showers and locker rooms, may require permanent changes in infrastructure, others may be as simple as adding healthier choices to vending machines. When conducting your environmental scan, note which changes may require more or less of an investment and which are realistic options at your worksite. For example, creating a space for physical activity may mean building, equipping, and staffing a fitness center. But it could also mean converting an existing but underused storage area or conference room into a suitable space for exercise. The point is to be objective in your examination, and look for creative ways to bridge any gaps identified in the assessment.
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Getting Started
Reviewing Company Policies and Data Examining company policies and manuals for opportunities to make changes may require assembling a team, including human resources staff, to look through records and collect any information on the company that might have an impact on the health of your employees. You may also collect other data, like insurance information, health care costs for your employees, and data from local health departments. These data will give you an idea of the current health status of your employees. Here are some things to look for:
Corporate Policies Examine company policies on things like tobacco use, rewards for participation in wellness programs, and subsidized cost of public transportation (so employees are more likely to walk as part of their commute). Make note of whether the policies support or pose a barrier to healthy behavior, or deter unhealthy behavior. Workforce Demographics Learn as much as you can about your company's workforce. What are their characteristics; i.e., age, gender, race, etc.? Think about how these characteristics might relate to the health concerns of your employees, what their interests might be, and how you might best be able to reach them. Benefits Package & Claims Data An examination of health benefits data can help reveal the health services utilized by employees, how often they tend to seek treatment, and from whom. Having this information can help you identify potential areas for interventions.
Assess Your Employees Next, you should assess employee interests and needs. This may take two forms:
Individual Health Risk Assessments These can include questions on personal and family medical history as well as physical examinations and medical tests.
Employee Surveys Survey to determine the interests, needs, and willingness of employees to participate in wellness programs. The results of this assessment will give you an idea of how widespread interest is in developing a wellness program at your worksite. This type of assessment can also be repeated as part of the program evaluation process.
The benefits of assessing employee risk... It provides the basis for employers to evaluate the greatest needs within their own employee populations, and to determine the most significant financial risk to their health plans. It allows employers to maximize the use of limited resources and prioritize where money and staff time is best allocated for maximum impact. It allows employers to develop a focused approach that minimizes the potential of rolling out fragmented and often-conflicting programs simultaneously.
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You'll find samples of the following employee assessments in the Resource section of this toolkit to assist you:
Individual Health Risk Assessments (Note: Consult with your company's human resources department or health plan provider regarding assessment tools already available.)
Readiness to Change Survey
Employees' Needs and Interests
Georgia Worksite Assessment Tool
Interpret Your Findings Analyze your data. What patterns do you see? What are the barriers to healthy behaviors your employees face? What are their interests? How many employees want to participate and in what kinds of programs? How would you prioritize your efforts? A frank analysis of the data you gather will reveal the best starting point and where you can have the greatest impact.
PREPARE FOR IMPLEMENTATION
Set Goals and Objectives Set reasonable long-term and short-term goals and objectives with specific objectives for your wellness program. Be as specific as possible, and describe the changes you expect to see as a result of your programs. Goals are general statements that help provide direction for the program. Objectives are specific, measurable, and have a specified time frame. They help to determine the effectiveness of the program.
Objectives should be SMART
S - Specific M - Measurable A - Achievable R - Realistic T - Time specific Objectives should tell who is doing what, where, when, and by how much. Example: By the end of the 12-week walking challenge, participants will have increased their daily steps by 2000.
Design Your Program Components As you consider your approach, keep in mind that employees will reap the greatest rewards through a broad-based approach that addresses multiple behaviors at different intervention levels. With this in mind, the Work Healthy Georgia toolkit provides all the resources and ideas you'll need to help you address everything from environmental policy to general wellness promotion. You'll find ideas to encourage disease prevention through physical activity, healthy eating, avoiding tobacco use, getting regular check-ups and screenings, and managing stress. And, you'll learn ways to identify and support employees who have chronic diseases.
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Develop a Budget For each element of your program, outline the costs and compare them to the results you described in your Goals and Objectives. Cost calculation can also be helpful in determining allocation of funds and justification to leadership. The worksheet in Section Six and the cost calculator in the following link will prove helpful:
Cost Calculator:
http://www.cdc.gov/leanworks/costcalculator/disclaimer.html
Create a Promotion Plan Promoting your activities is a key step in the successful delivery of a worksite wellness program. When carried out properly, a promotion plan informs employees and gets them excited. Be creative with your advertising and have some fun! Here are some ideas:
Be visible Branding your program is an effective way to create visibility. Develop a name and logo that will be easy to recognize and can be easily linked back to your wellness program efforts. Use the wellness program name and logo on all materials, flyers, e-mails, and promotional items.
Find the "hot spots" Identify high traffic areas in your building, such as break rooms, bathrooms, coffee machines, water coolers, etc. These are the areas you will want to target for your promotional materials. Make sure that the information is clear, easy to understand, and printed in large enough letters so that people can read it easily. Always let employees know how they can sign up and who they can contact for details.
Diversify To successfully get your message out, you need to think about using all channels of communication at your disposal. For example, company billboards, newsletters, and internet or intranet sites are just a few ways you can diversity your promotional efforts. Once you've decided where you will promote, you can choose what type of materials to utilize. There are several options to choose from, including posters, table tents, paycheck stuffers, or emails. Be sure to include the basics: who, what, why, when, and where.
Timing is everything Another step to effective promotion is determining the right time to deliver the message. You may want to take advantage of company-wide or departmental meetings, luncheons, or social gatherings such as a holiday party or birthday celebration.
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Enroll informal leaders Think about this: If you stripped away everybody's job title, who would people choose to follow? Once you have answered this question, you have successfully identified your company's informal leadership. These are the key people that you want to take part in your program. Leverage their participation by using them as honorary chairpersons.
Create a "Mission Control" Designate a central location where employees can learn about and access program information.
Use email Send weekly emails to keep in touch with participants. This is a fast and convenient method to send out pre- and post-program campaign surveys and evaluations. Or you could e-mail participants supplemental websites that can serve as helpful references during the program.
Advertise Promote the program in company newsletters, memos, meetings, intranet, or paycheck stuffers.
Send out mailings If your budget allows, mail tri-fold flyers to employees' homes informing them of the upcoming program. Keep in mind that these mailings should not only be informative, but visually appealing enough to hold interest (i.e., they should not be crammed with text). This is also helpful for employees without computer access at home or work.
Get in touch with management Inform department heads of the program and encourage them to pass on the information. Make sure you leave them with a hard copy of the information a registration form, for instance so they can pass it on to their employees.
Entice participants Offer incentives to employees who participate and complete walking or other structured programs.
Schedule guest speakers Arrange for fitness, nutrition, or stress management experts to offer tips during lunch-and-learn sessions.
The bottom line The best way to ensure high participation is to use as many means and methods as possible. Different people respond to different stimuli, so in most cases, going the extra mile pays big dividends.
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IMPLEMENT YOUR PROGRAM AND MAINTAIN EMPLOYEE INTEREST
Now it's time to implement your program. This execution stage will test how well you have prepared and planned. If you've taken the necessary steps, successfully delivering the program will be a breeze.
Stay connected Provide opportunities for employees to continue to receive encouragement and information. Make use of emails and bulletin boards as ways to maintain interest and create visibility for your program. One-on-one meetings can also give participants an opportunity to express any concerns they may have. It can also be motivating for employees to know that you are in tune and concerned with their progress.
Track and monitor Monitoring participant progress is important throughout the campaign, not only at the close of the program. This will enable you to identify and award incentives to the most deserving participants as you go along.
Celebrate! When it's time to recognize program victories, pull out all the stops and organize a celebration no one will want to miss. Advertise the celebration throughout your organization, invite senior level executives, and get them to present the awards.
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Getting Started
Capitalize on Incentives, Awards, and Competition Incentives can make or break a program. Realizing that individuals must themselves be determined to change, incentives, awards, and competition provide added motivation to facilitate the process. Incentives can be used to encourage program participation and completion. They can also be used to reward certain behaviors and outcomes.

Incentive Suggestions

I Gift certificates for local fitness stores I Walking shoes I Day passes to the local fitness club I Health magazine subscription I Water bottles I Stopwatches I Gift certificates to local health food stores I Gym bags I Exercise equipment (e.g.: dumbbells,
resistance bands, ankle weights, etc.)

I Pedometers I Walking videos I Motivational books I T-shirts I Hats/Visors I A "well" day off I Free massages I Healthy cookbooks

If you offer incentives employees like, they will most likely come back for more. However, if you are not in touch with what employees want, you run the risk of losing their interest in the program. You may want to send out a questionnaire ahead of time to get an idea of what incentives motivate employees.
Most important, make sure employees are rewarded for their accomplishments in a visible meeting or special ceremony. The fact that they are being recognized in public can be an incentive in itself.

Tips for Using Incentives

I Avoid words like "best" and "most" I Work within your budget

I Recognize achievements

I Find other ways of giving financial incentives

I Use incentives that reinforce

like health benefit credits

healthy behavior

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Getting Started
MONITOR AND EVALUATE YOUR RESULTS
The evaluation process is nothing to fear! This stage of the program is crucial in determining what works and what doesn't, so don't be tempted to skip it. Evaluating your efforts will help you decipher which program elements should be kept, which should be improved, and which should be eliminated. And demonstrating success is a good way to garner ongoing program support. Here are some ways to take an objective look:
Distribute pre- and post-program surveys to participants Be sure to distribute the same survey, or ask the same survey questions, that participants were given before the program's start in order to measure any improvement. This will give you a solid point to compare pre- and post-results.
Hand out confidential program evaluation forms Having completed the program, each participant should have ample opportunity to provide feedback. Their comments about the program can provide critical information for improving your wellness initiative. Be sure to keep it confidential especially if you're gathering personal medical information.
Complete an evaluation report You can use this evaluation to scrutinize how well you and the company are doing, as a whole, in providing employees the means to improve their health.
Communicate the results Once you have collected and analyzed all of the evaluation materials, it is important that you relay the information to participants and management as needed.
The bottom line Do not confuse evaluation with research. Research is the process you go through to prove the worth of a program. Evaluation is the process you use to improve your program. Consistent attention to evaluation will yield consistent improvements to your program.
Methods of evaluation can include: I Measuring risk factors before and after program (e.g. increases in physical activity or
fruit/vegetable consumption, or decrease in tobacco usage). I Conducting pre- and post-tests to assess behavior change. I Using participant surveys to assess satisfaction and capture suggestions about
future programs. I Comparing absenteeism data before and after program.
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Getting Started
Launching a Structured Health Campaign Sample Checklist and Proposed Timeline
Implementing a worksite wellness initiative takes a lot of time, effort, and dedication. Although it would be ideal for everything to run smoothly, this is not always the case. The proposed timeline should ensure that essential elements are not overlooked.
90 days or more in advance I Obtain management approval I Set goals and objectives I Select a wellness team I Organize a budget I Set a time and date
60 days in advance I Reserve space for the kick-off event I Promote the campaign I Identify places to post promotional materials
30 days in advance I Distribute registration forms I Hold a meeting to review campaign specifics I Promote kick-off date
15 days in advance I Collect registration forms I Distribute pre-campaign surveys to participants I Organize participant materials
Campaign Start I Hold a kick-off event I Introduce campaign goals and objectives to participants I Distribute materials to participants
Throughout the campaign I Distribute materials (as appropriate) I Monitor participant progress I Keep up with incentives (this may not apply to everyone) I Keep up communication with participants
End of Campaign I Hold a celebration event I Award outstanding individuals for meeting their goals I Distribute post-campaign surveys to participants I Hand out program evaluations I Hold a meeting with participants and management to communicate results
After the Campaign I Follow-up with participants to ensure they are maintaining their goals I Recruit the most successful participants for future wellness efforts I End of Campaign
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SECTION TWO RESOURCES
Leutzinger, J. (2005). Building Your Wellness Budget. WELCOA's Absolute Advantage Magazine, 4(10), 2-5. Available at: http://welcoa.org/freeresources/pdf/wellness_budget.pdf WELCOA. Employee Needs and Interest Survey. Available at: http://welcoa.org/freeresources/pdf/ni_survey.pdf Hunnicutt, D. (2007). By The Numbers. WELCOA's Absolute Advantage Magazine, 6(4), 10-17. Available at: http://welcoa.org/freeresources/pdf/by_the_numbers.pdf Centers for Disease Control and Prevention. Walkability Audit. Available at: http://www.cdc.gov/nccdphp/dnpao/hwi/toolkits/walkability/audit_tool.htm CDC Healthier Worksite Initiative. Available at: http://www.cdc.gov/nccdphp/dnpa/hwi/index.htm American Cancer Society Workplace Solutions - http://www.acsworkplacesolutions.com National Business Group on Health. Health Improvements: A comprehensive guide to planning, implementing, and evaluating worksite programs. Available at: http://www.businessgrouphealth.org/pdfs/issuebrief_nov2004.pdf
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Notes
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Section Three
DESIGNING YOUR PROGRAM-
A COMPREHENSIVE APPROACH
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DESIGNING AND CHOOSING PROGRAM COMPONENTS
Certainly, when structuring your worksite wellness program, any change that helps employees adopt healthier habits is a change for the better. However, a truly comprehensive approach should target each of the dynamics that contribute to adopting and maintaining healthier behaviors:
Environmental changes Creating the infrastructure to support healthier behaviors Policy changes Establishing incentives to reward healthier behaviors Individual behavior change programs Crafting targeted programs to encourage healthier
behaviors and prevent or slow the progression of disease Awareness and communication vehicles Raising awareness about the importance of
pursuing healthier behaviors Formal and informal leadership structure Capitalizing on influence and resources
throughout the organization Social support networks Setting the stage for meaningful relationships that will
encourage long-term success While it is not necessary to implement all components of the comprehensive model at one time, plan to add components in a systematic and incremental fashion. The costs associated with implementing the different program components vary from very small to very large, and gradual implementation may be the more feasible approach. While different components can be phased in over time, it's important to realize that environmental, policy, and awareness efforts are fundamental to ensuring adoption of and adherence to the behavioral change and education pieces.
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ENVIRONMENTAL CHANGES
Is the physical environment your employees are exposed to conducive to change? Physical environment interventions contribute to behavior change. They create situations that make it easier for people to engage in the desired behaviors, whether they are aware of it or not, while making it more difficult to engage in less desirable behavior.
Environmental Change Might Include...
Physical Activity:
I Build showers and changing rooms. I Install bicycle racks and other supports that
facilitate bicycling to work. I Build walking paths and recreational facilities
on-site or nearby.
Healthier Eating:
I Make healthy foods and meals available in worksite cafeterias and vending machines.
I Ensure access to fresh fruits and vegetables through worksite gardens or produce markets.
I Provide refrigerated storage and on-site preparation facilities in lunch rooms to encourage employees to bring healthier foods to work.
Tobacco Use:
I Create worksite environments that prohibit smoking and eliminate exposure to second-hand smoke.
I Remove tobacco products from vending machines.
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POLICY CHANGES
Likewise, do your company policies encourage and support healthy behavior changes in the workplace? Because company policies reflect the company mission and values, policy changes are an important starting point for implementing worksite wellness programs.
Policies include all of the laws, ordinances, rules, regulations, guidelines or protocols that direct how people should behave within a specified area, jurisdiction, or organization. While not all policies are written, any change in official practice that is initiated and adopted as the practice to be followed throughout the entire organization can be considered a "policy." While policies are most effective when written, keep in mind that policies that are reinforced by all levels of management as central to the core mission and values of the organization will be more powerful than policies that exist on paper only.
For worksites, policies can include the adoption of protocols or guidelines that all employees are to support or follow; they must be enforced to be effective. While enforcement usually implies a penalty attached to infractions, there may also be incentives or rewards attached for compliance which can prove especially useful in your efforts to encourage healthy behavior changes in the workplace. Adherence to policies may also be included as a core element of company performance measures or reviews.
As you proceed with the development of your program, be sure to review your new policies during new employee orientation and stress the changes during company meetings on an ongoing basis.
Policy Changes Might Include...
Physical Activity:
I Allow employees to take an additional fifteen or thirty minutes during the day to go walking on-site.
I Reimburse or subsidize gym membership (maybe start with those identified as being high-risk).
Healthier Eating:
I Serve only healthy snacks and beverages at all company meetings or functions.
Tobacco Use:
I Adopt a 100% tobacco-free worksite policy that includes all company vehicles.
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INDIVIDUAL BEHAVIOR CHANGE PROGRAMS
Individual behavior change programs include programs that provide information and build skills, and that address strategies to adopt and maintain behavior changes. These are the activities most often associated with traditional "wellness programs." A variety of group- and individualbased programs using instructional coaching and social support can be employed to encourage individual change in a step-by-step fashion.
Settings for individual behavior change programs can be one-on-one (patient education, directed counseling), small or large group (traditional teaching or lecture setting), or computeror web-based. In addition to providing specifics about prevention and self-management of chronic diseases, these programs also help participants learn how to make changes permanent and avoid relapses. A number of non-profit organizations offer ready-to-implement programs, such as the American Heart Association, National Diabetes Education Program, American Lung Association. Classes offered might include:
Physical Activity Programs Teaching participants about the benefits of physical activity and providing guidelines related to recommended frequency, intensity, duration, and mode of exercise
Nutrition Classes Covering different food categories or groups, portions and portion sizes, how to read nutrition labels, how to select healthier foods, how to prepare foods, how to plan meals, and other practical aspects of making healthy food choices
Tobacco Cessation Programs Offering counseling for tobacco addiction and support for maintaining a tobacco-free life
To encourage employees to participate in these programs, it may be important to allow time off work to attend. One alternative is to pay or subsidize the costs of these programs off-site. Off-site programs may be less expensive, although attention should be paid to the credentials of instructors and the quality of services and programs offered. Enrollment and continued participation in off-site programs may be lower unless family members are encouraged to participate, as well. Keep in mind that transportation, child care, and other factors may inhibit employee participation in off-site programs.
Individual behavior change programs have a structured curriculum and are implemented in multiple sessions. Individual behavior change programs
might include... I Encouraging participants to take small steps to success I Providing opportunities to practice new behaviors with real
"hands-on" experiences I Encouraging self-reporting (self-monitoring) and self-discovery I Teaching participants goal-setting and how to contract for
success I Teaching knowledge and skills to initiate and maintain the
behavior I Addressing, maintaining, or regaining healthy habits during
times of stress or turmoil
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AWARENESS AND COMMUNICATION VEHICLES
Communication and awareness activities include anything designed to raise awareness about the importance of adopting healthier behaviors and motivating individuals to change. You might consider this as "internal advertising or marketing" directed at your employees rather than your clients or consumers. Information about healthy actions or choices should be communicated in clear and specific terms. Messages should be relevant to the audience, personally meaningful, and specific enough to set the stage for future action. Materials should appeal to the eye, capture attention, and promote a positive reaction and they should be rotated or changed at intervals to continue to elicite a response. And finally, they must persuade and encourage employees to make and maintain the changes. Many non-profit health organizations and the federal government provide materials that can be found online, downloaded, and duplicated at no cost.
Employee Public Awareness Efforts Might Include...
I Post point of decision prompts or signage around your worksite that promote a desired behavior, such as taking the stairs instead of the elevator, choosing fruit as a snack, or maintaining the company's smoke-free policy.
I Health features on bulletin boards or at meetings. I Articles in employee newsletters. I Guest speakers at meetings to discuss various health topics. I Resource guides, brochures, and tip sheets.
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FORMAL AND INFORMAL LEADERSHIP STRUCTURES
Certainly, the formal leadership structure of your company must come out in support of your initiative for it to be taken seriously. However, targeting informal leadership is equally crucial to fostering employee engagement. These informal leaders will produce buy-in from employees at all levels of the organization. Leaders can be trained to serve as spokespersons or to lead change efforts within their organizational units. Leaders also perform a vital function in worksite wellness programs by reporting on the successes or needs of different worksite wellness initiatives, and they can provide a natural conduit for feedback from their staff to the worksite wellness team.
Worksite wellness should be on the agenda at all meetings of internal leadership staff, and the active support of and participation in worksite wellness should be an important responsibility for leadership, both formal and informal. Keep in mind that leaders should be provided with all the training and materials they will need to support and function as leaders in the worksite wellness effort.
Identifying strategies for enlisting leadership support for worksite wellness should be incorporated into planning and developing your program from the very beginning. There is often a ready supply of training and materials through various non-profit and for-profit organizations. Many individuals, because of their own or their family's history, have an interest in particular chronic diseases and would welcome the opportunity to make a contribution to improving their colleagues' health. While individuals may contribute their time and energy, including leadership in worksite wellness initiatives costs little and yields much.
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THREE

SOCIAL SUPPORT NETWORKS
Building social support for change is another dynamic component to consider in promoting worksite wellness. In fact, the social support participants offer each other can be as valuable as the specific information provided by an instructor or program guide in sustaining behavior change, because learning is enhanced by interaction with others who share ideas and common life experiences.
Social support activities create opportunities for people to interact in positive and meaningful ways. Such activities can include setting up a "buddy system," having open discussion groups, structuring playful competitions, establishing informal support groups, or even on-line or telephonic coaching systems. Team, buddy, and support group settings encourage ongoing participation in the behavior rather than instruction in the knowledge or skills related to adoption of the behavior. Recognition of accomplishments at company meetings and events is also an important aspect of social support that should be built into your worksite wellness program.
Developing and setting up social support programs should accompany any initiative or effort to formally instruct employees about physical activity, healthier eating, or tobacco cessation. One example of a social support program for physical activity would be to encourage walking groups or clubs, recipe swaps for healthy eating, and tobacco cessation buddies willing to offer encouragement during quit attempts. Another important aspect of social support for many employees is their families. Employees should be encouraged to share materials and messages with their family members and to include them in wellness programs whenever possible.
As with establishing a leadership structure, identifying strategies for building social support programs into your worksite wellness efforts should be incorporated into the planning and development of your program from the outset. Both leadership participation and social support activities contribute to increased team cohesion, higher morale, and greater enthusiasm for the employer overall, and can both impact the bottom line and reduce health care costs.

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SECTION THREE RESOURCES
Georgia Department of Public Health - www.health.state.ga.us Cohen L, Swift S. The spectrum of prevention: developing a comprehensive approach to injury prevention. Injury Prevention. 1999;5:203-207. Available at: http://www.preventioninstitute.org/pdf/spectrum_injury.pdf American Journal of Health Promotion - www.healthpromotionjournal.com National Business Group on Health - http://www.businessgrouphealth.org CDC Healthier Worksite Initiative. Available at: http://www.cdc.gov/nccdphp/dnpa/hwi/index.htm Guide to Community and Preventive Services - www.thecommunityguide.org
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Notes
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Section Four
FOCUS AREAS FOR ALL EMPLOYEES
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Focus Areas For All Employees
If you've decided that a health promotion program that encourages all employees to adopt healthy lifestyle choices is the right fit for you, this section of the Work Healthy Georgia toolkit will provide you with a wealth of resources and ideas centered around five key areas essential to good health:
Eat Healthy Be Active Be Smoke-Free Get Checked Be Positive
This section will give you ideas for specific programs you can implement in each of the five areas.
EAT HEALTHY
Eating healthy is an individual choice, but a company or organization can help its employees by making those choices easier. Five major actions can contribute greatly to your employees' ability to make healthier eating choices.
Make healthy food choices available, appealing, and low-cost Sponsor healthy cooking demonstrations that are fun, accessible, and convenient Offer an on-site weight management program that focuses on healthy eating Work with your cafeteria or catering service to promote a healthy nutrition program Provide clean and convenient space for breastfeeding mothers Provide space where employees can store and heat-up healthy meals (including a
refrigerator)
Make healthy food choices available, appealing, and low cost... One way to promote healthful eating to your employees is to ensure they have healthy choices available to them during the workday.
Hints I Consider the sources of food in your workplace (e.g., vending machines, snack bars, cafeterias, catering, and break rooms). How many sources of food do your employees have? If there is only once source, like a vending machine, this effort may be an especially powerful tool in your workplace wellness program. Make a list of these sources, with a short description, on a map of your building. I Identify an employee to assess the interest in and need for including healthful options Identify an employee to assess the interest in, and need for, including healthful options at each source. This assessment might be conducted via an informal meeting, an on-line survey, a questionnaire, or individual interviews. The assessment should include preferences for specific items at each source. Do your employees want a salad bar in the cafeteria? Energy bars, pretzels, and water in the vending machines? Low-fat milk, yogurt, and juice in the break room? Smoothies at the snack bar?
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Focus Areas For All Employees
I Create a brief proposal for each source, listing the types and amounts of the healthful choices identified by the employees, as well as acceptable costs.
I Identify the operational manager that oversees each source, and share your proposal with him or her. If the source is managed externally, find out when the contract expires and schedule the meeting a few months in advance of the contract renewal.
I At each meeting, discuss your overall workplace wellness program, the results of the employee survey, and your proposal. Agree upon a plan to move forward.
I Publicize the new choices. Recruit enthusiastic employees to discuss the choices with their colleagues. Post signs in each area emphasizing the new, healthy options. Make an announcement at the next staff meeting. Send an email from the wellness program sponsor. Send regular updates and vary the signage to maintain interest.
I Track sales, and include results in your overall wellness program reports to management.
Sponsor healthy cooking demonstrations that are fun, accessible, and convenient... When your employees see healthy food being prepared quickly and with minimal fuss and equipment, they can more easily imagine themselves preparing healthy meals at home. A "Lunch & Learn" cooking demonstration can be organized quickly with your cafeteria's help, and is especially appealing with a theme like "Healthy Dinner Tonight, Healthy Lunch Tomorrow." Add a taste test as an extra incentive.
Hints I Vary your themes: Dinner in a Flash; Healthy Dinner Tonight, Healthy Lunch Tomorrow; Valentines' Day for Your Heart; Summertime Slimmers. I Recruit your onsite food service, local Cooperative Extension Service, a local chef, or a nearby culinary academy to lead the demonstration. Follow the demonstration with a cooking class for those interested in more information. I Add suspense with a timer: the chef has to "prove" he/she can complete the recipe in twenty minutes or less. I Coordinate a "used book fair" of healthy cookbooks and cooking videos. Each person who brings a book or video can take another home. I Offer a door prize at the demonstration, like a subscription to a healthy eating magazine. I Provide printed recipes with shopping lists that people can take home. If you do not have cooking facilities, demonstrate chilled or cold recipes.
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Focus Areas For All Employees
Offer an onsite weight management program that focuses on healthy eating... Ongoing programs, like one that focuses on healthy eating can provide employees with a support system that can motivate them to change behaviors long-term.
Hints I Conduct an employee survey to determine the most convenient time for meetings. Common times are before work, during lunch, or immediately after work. I Survey to find out the topics that are most important to your employees (e.g., diet, exercise, supplementation, prepared meals, packaged meals). Compile a list of requirements from the results. I Research programs available through public offerings that match your requirements. Review their content to ensure it is consistent with the rest of your programs. Also, consider the qualifications and reputations of the instructors, as well as the cost. I Request that the company subsidize part of the program, so that employee and employer share the costs. I If a public program offering is not available in your community, check with registered dietitians to see if they have their own programs.
Work with your cafeteria or catering service to promote a healthy nutrition program... Dietitians recommend that Americans eat five to nine servings of fruits and vegetables a day. Think creatively to recognize new opportunities for promoting healthy eating and snacking to your employees through the cafeteria or other vendors.
Hints I Develop a healthy meeting policy with recommendations on serving fruits and vegetables at all worksite meetings where food is catered. I Require vendors to include healthy foods in vending machines, such as snacks that are low fat, low sodium and high fiber. Include water and 100% juice in all on-site vending machines. I Conduct a healthy cooking demonstration in the cafeteria using fruits and vegetables. Focus on meals that can be prepared quickly, and provide leftovers for the next day's healthy lunch. I Promote a nutrition week or month in the cafeteria. March is National Nutrition Month, and resource materials are usually available online. I Write or solicit a regular dietitian column in your company newsletter or intranet homepage. Consider contacting the Cooperative Extension Service to provide the material. I Ask the cafeteria to promote a healthy fruit or vegetable option every day. I Give fruit baskets as employee recognition awards. I Explore the possibility of weekly "produce markets" with local farmers, or even sponsoring a company vegetable garden on-site.
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Focus Areas For All Employees
Provide clean and convenient space for breastfeeding mothers... Babies need to eat healthy too! One study found that babies who were not breastfed incurred an additional $31 to $475 in health care costs on average in their first year of life, as compared to their breastfed counterparts.12 In addition, breastfed babies are less likely to be ill, which means their mothers will need to spend less time away from the office to care for them. Giving lactating mothers a convenient place to breastfeed or pump breast milk can help reduce turnover, as mothers will be more likely to return to work after their maternity leave. Make no mistake: organizations with programs that promote breastfeeding enjoy the reputation of being concerned about the wellness of their employees!
Hints I Create a breastfeeding task force to provide mothers with a support system. I Designate a lactation room that is clean, private and comfortable. Include a comfortable chair or chairs, a sink for washing breast pump parts, and a refrigerator. The space should not be a bathroom. I Use your company's intranet, website, or employee newsletter to communicate breastfeeding policies. I Allow sufficient break times for expressing milk or feeding the baby. I Explore company discounts on nursing supplies. I Voice your support of local, state, and federal breastfeeding legislation.
BE ACTIVE
Many employees spend the majority of their waking hours at work, which gives employers a prime opportunity to encourage employees to increase their activity levels throughout the day. Here are some major actions you can take:
Establish employee activity groups Encourage movement "micro-breaks" throughout the work day Set up incentives and challenges to encourage increased activity levels Offer flexible work hours to allow for physical activity outside of work Install bike racks near employee entrances Provide clean, safe, and appealing stairwells Provide onsite fitness opportunities and facilities Coordinate partnerships with local fitness facilities
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Establish employee activity groups... Providing a forum for employees with similar fitness interests can encourage increased activity outside the workplace. Employees who have an interest in walking, running, basketball, or bicycling may take action if supported by others with the same interests. Those already engaged in these activities may be willing to help others in your organization get started. As an added bonus, these groups also foster team relationships that will translate over to general work activities, and provide an outlet for stress.
Hints I Gain the support of company leadership, as well as human resources and legal departments in sponsoring formal or informal group or team activities. I Provide a "marketplace" for employees with common interests to find each other. This might be formal or informal, e.g., a bulletin board or website. I Start small. Survey employees for areas of interest, and initiate one or two groups to start. I Sponsor local intramural leagues with other employers.
Encourage movement "micro-breaks" throughout the workday... In addition to creating movement, a "micro-break" can help relieve the pain and discomfort associated with poor posture. These breaks can consist of stretches, a quick hallway walk, self-massage, or the use of a relaxation technique. Instructor-led formats can also prove useful. These breaks reduce the muscle tension that is caused when muscles remain in one position for too long, or when muscles perform the same movement over and over. In addition, the risk of repetitive strain injury can be reduced when employees take short stretch or movement breaks throughout the day.
Hints I Ask employees to set a reminder in their daily calendars or email to take a 2-3 minute break once per hour. Software is available that can remind employees to take these breaks and give them instructions on activities such as desk stretches, walk, etc. I Provide materials like posters or flyers with educational content on stretches and self-massage, especially for those without computer access. I Host instructor-led breaks in a conference room and provide stretching instructions, mini-massage, resistance training, and other techniques. Offer a new technique monthly.
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Set up incentives and challenges to encourage increased activity levels... Encouraging your employees to add even small amounts of physical activity each day can motivate them to maintain positive health changes. Incentive-based programs are effective ways to help your employees take the first step to a more active lifestlye. Incentive programs can be small or large, and they do not have to be expensive to be effective.
Hints I Design your incentives so that people of all fitness levels can participate. Offer prizes for different levels of achievement. I Pedometer programs encourage walking by helping employees track their steps over the course of a normal day. For example, a 12-week walking challenge could reward employees who increase their steps by different percentages. Similar programs could encourage a wide variety of activities, like dancing, cycling, swimming, weight lifting, yoga, and stretching. Employees could track their participation on a special form and receive points for different types of activities and the duration of time they were active. I Reward employees with prizes consistent with a wellness program: gift certificates to health food stores, massages, sporting goods stores, or the local farmer's market.
Offer flexible work hours to allow for physical activity outside of work... One of the easiest ways to encourage employees to increase their activity levels is to provide the flexibility in their work hours that will allow them time to do so. Companies can stagger start and end times for employees who want to participate in physical activity before or after work. Alternatively, consider allowing a longer lunch break for physical activity. Many employees would appreciate the ability to run, walk, or cycle during the day if they had flexible time made available to them, along with supportive facilities. Keep in mind that grooming time may vary among employees.
Hints I Develop a company statement that articulates the organization's position on flexible work hours for fitness activities. Define clear roles and processes for approving work hour flexibility for physical fitness. I Provide clean, well-maintained showers and locker rooms that will support runners, joggers, walkers, and cyclists. I Post clear policies on the use of the locker rooms and lockers.
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Install bike racks near employee entrances... Cycling is a healthy behavior that can be easily encouraged at the workplace by providing secure, convenient bicycle racks to encourage your employees to cycle to and from work, or cycle during lunch. Consider that bicycle parking is much less expensive to provide than automobile parking. Hints
I Install a bike rack close to the building entrance. It should be in an area that is well lit and situated so that cyclists can ride the bike directly into the rack. Select an inverted U-rack, which is regarded as the standard by cyclists.
I If you have multiple building entrances, install multiple racks so that employees can park as close as possible to their normal office entrance. The more convenient you can make it, the more likely your employees will be to take advantage of the racks. Be sure to check with your local government to see if there are any ordinances about the type of rack that must be used or its location on your property.
I Advertise the locations of the racks in your employee newsletter, internal website, or other communication vehicles.
I Offer bicycle registration through your local police department. Some departments will engrave a number on a bike so that a stolen bike can be traced back to its owner.
I Encourage bicycle commuting by installing showers and lockers in existing restrooms. I Offer free or discounted bicycle helmets and reflective safety gear to bicycle commuters.
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Provide clean, safe, and appealing stairwells... Taking the stairs is a great and simple way for your employees to incorporate physical activity into their daily routines. If you have stairs in your building, consider how you might improve the appearance of the stairwells to encourage employees to take the stairs more often.
Hints I Paint the walls in the stairwells with bright, attractive colors. I Put up motivational signs outside stairwells and near elevators encouraging employees to take the stairs. I Hang artwork in stairwells. This can be items purchased, or even pictures painted by the children of employees. I Install better lighting. You may even consider using something creative like track lighting. I Add carpet or rubber treading to reduce slippage on the stairs.
Provide on-site fitness opportunities and facilities... As you can see from the previous examples, you do not have to install a full-service, staffed gym to offer your employees fitness opportunities at the worksite (although many people do appreciate convenient access to a full gym at work). Instead, consider other options:
Hints I Alter your landscaping to include walking trails. Many people report that walking is their most common and preferred fitness activity. I Dedicate a conference room for inexpensive fitness basics such as fitness videos and equipment, exercise balls, yoga mats, small hand weights, instructional posters, and stretch bands. I Provide an intermediate-level exercise facility that includes a universal weight machine; a small number of cardiovascular machines like stair-steppers, elliptical, or rowing machines; and a shower/locker room.
Cover Your Bases... If you plan to provide equipment or offer exercise programs on-site, make sure participants are aware of risk of injury related to exercise and that they complete a disclaimer/waiver before taking part in such activities.
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Coordinate partnerships with local fitness facilities... If you cannot improve your own facilities to encourage physical activity on-site, consider a partnership with a nearby health club, recreation center, or YMCA and offer your employees discounted memberships. Hints
I Ask area fitness facilities about corporate packages. They may have an existing discount structure that you can leverage for your company.
I Encourage your employees to join in groups or to attend specific classes together. People are more likely to stick with an activity if they have company.
I Try to find a facility that also offers discounted family memberships to encourage family participation in physical activities.
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BE SMOKE FREE
The high prevalence of smoking and the severity of associated health risks make tobacco use an important health topic in the workplace. Although studies show that 70% of tobacco users say they want to quit, people often need to try quitting several times before they are successful. Research shows that tobacco users are two to three times more likely to quit successfully when they have help.13 Employers can play an important role in helping smokers and oral tobacco users kick the habit utilizing an evidence-based approach that includes tobacco cessation as the gold standard for wellness programs. Here are some positive steps you can make in that direction:
Establish and enforce tobacco-free worksite policies Add coverage for smoking cessation services to your company's health benefits Establish onsite tobacco cessation initiatives
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Establish and enforce tobacco-free worksite policies . . . The Georgia Smoke Free Air Act of 2005 became effective on July 1, 2005. Prior to this date, there was no state law regulating tobacco use at worksites. Although the law prohibits tobacco use in most public areas, it does not address campus-wide restrictions, nor does it restrict the use of "spit" tobacco. Thus, individual steps are necessary to establish a comprehensive tobacco-free policy that does not allow tobacco use, including "spit" tobacco, anywhere on the worksite campus. A comprehensive tobacco-free workplace policy not only protects non-tobacco users from secondhand smoke exposure, it also makes it easier for tobacco users to quit. Tobacco users who face these restrictions consume less tobacco and quit at a much higher than average rate.14 By comparison, milder tobacco-free workplace policies have much less impact on quitting rates and very little effect on consumption. Hints
I Institute a comprehensive tobacco-free (not just smoke-free) policy. The policy should apply to the entire worksite campus, including indoor and outdoor areas, leased or shared facilities, and vehicles.
I Policies should also prohibit tobacco use near the entrances to buildings, with the legal clearance footage specified. Keep in mind that the most effective "gold standard" policies do not allow for designated smoking areas or separately ventilated smoking facilities.
I Post signage indoors and outdoors to alert employees and visitors of the worksite policy. I Communicate and enforce the policy with an integrated, non-punitive message. For
example: "We care about your health. The company offers the following programs and supports to help you stop using tobacco."
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Add coverage for smoking cessation services to your company's health insurance benefits... Because most Americans receive their health coverage through employers, tobacco cessation counseling is one of the best investments to support the health of employees. In a recent report, tobacco cessation counseling ranked second only to childhood vaccinations for its value in disease prevention and cost effectiveness.15 Ideally, the health plan coverage would ensure that evidence-based tobacco treatments that include counseling and medications be made available to employees at no cost. Hints
I Contract directly with the American Lung Association, American Cancer Society or with quit-line vendors to offer worksite cessation services to employees.
I Include reimbursement accounts so that employees can receive 100% reimbursement for all evidence-based tobacco cessation treatments. Ensure that deductibles, co-pays, and co-insurance do not apply. Eliminating financial barriers to quitting facilitates getting more people into treatment.
I Communicate to employees the types of cessation benefits that are covered under the company health plan.
The Georgia Tobacco Quit Line currently provides telephone counseling, follow-up, and referral to local resources. It also includes a web-based service, Web CoachTM, at no cost to Georgia residents. For more information call:
1-877-270-STOP (7867) 1-877-2NO-FUME (266-3863-Spanish)
or 1-877-777-6534 (TTY)
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Establish onsite tobacco cessation initiatives . . . Providing a low- or no-cost tobacco cessation program at your worksite can make participation in such programs even easier for your employees. These initiatives demonstrate that you and your company are committed to making a sincere effort to help employees quit using tobacco. A comprehensive cessation program will include a strategy that addresses the needs of all five distinct groups of employees and their dependents:
Tobacco users who want to quit
Tobacco users who are not ready to stop, but who may be motivated through incentives/disincentives, education and workplace policies
Recent ex-tobacco users who may require follow-up support to prevent relapse
Non-tobacco users who do not want to be exposed to secondhand smoke
Supervisors and managers, who need practical guidelines, resources, and enforcement strategies for implementing tobacco policies and addressing conflicts between tobacco and non-tobacco users
Hints I Provide tobacco cessation brochures in break rooms, restrooms, and other public areas. Communicate the benefits of quitting, as well as the resources and benefits available to employees, in your company newsletter, intranet, and other communication vehicles. I Invite guest speakers from the community to discuss the positive impact of quitting on wellness and good health. I Train existing onsite medical personnel (e.g. occupational health nurses, physician assistants, physicians) in tobacco cessation counseling and on available referral resources. Develop a referral form, and make it a policy to ask about and counsel on tobacco cessation at every visit. I Provide health risk appraisals as part of your health fair. I Participate in special events like The American Cancer Society's Great American Smokeout, and promote quitting during optimal times of the year, such as the beginning of a new year, when people have made health-related resolutions. I Develop rewards and incentives for employees who successfully reach their cessation goals.

GEORGIA SMOKEFREE AIR ACT RESOURCES
I Georgia Smokefree Air Act of 2005: A guide for business owners and employers

I Sample workplace signage

I Employee brochures

I Fact sheets

Go to: http://livehealthygeorgia.org

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TOBACCO FREE POLICY IMPLEMENTATION PLAN
Action Steps Set up a committee or task force to oversee the policy implementation process. Include District Health Directors, management, and employees (tobacco and non-tobacco users). Gather information to educate the taskforce and employees. Survey your employees about their knowledge and concerns about the policy so that concerns can be addressed before the policy goes into effect. Create a communication plan. Make sure that the policy is clear and simple. Set up an enforcement policy that is consistent with other personnel policies and disciplinary procedures.
Announce the policy several months before the start date with a letter from the Commissioner. Train managers on how to handle worker concerns and questions. Educate DPH employees about the reasons for the policy by using webinars, the DPH weekly newsletter, or a series of informational meetings.
There are two main components to consider when implementing a tobacco free campus initiative the policy and employee cessation services. These two components can be implemented by the worksite simultaneously or sequentially. It is recommended that the Department of Public Health promote cessation services prior to implementing the Tobacco Free Policy. This will allow employees to inquire about cessation services and it will show that the department is taking a supportive and non-punitive stance towards employees who use tobacco products.
Offer Cessation Services Approaches to implementing cessation services can depend on a variety of factors. To ensure that employees receive the most accurate information, meet with State Heath Benefit Plan and their cessation service provider. Discuss how they can ensure that cessation services are evidence-based and readily available prior to policy implementation. Since there is a tobacco surcharge for state of Georgia employees, get specific details on how employees can get the surcharge removed. Prepare to include this in your communication plan. Ask for data or documentation on how many DPH employees have succeeded in quitting during the policy implementation period and up to six months after implementation.
Prior to meeting with State Health Benefit Plan, discuss a communication plan with the Communications Department. Consider how you want to craft the message regarding both the policy and the availability of cessation services. Include the different channels in which employees can initiate cessation services (e.g., phone call, online, visiting their healthcare provider).
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Announcing the Policy If the planning committee or taskforce decided to implement cessation services before the policy has been implemented, consider announcing to employees that the tobacco free policy is coming soon. The announcement should come from the Commissioner or District Health Director (for district staff).
The planning committee should decide on a date when the policy will take effect, allowing for sufficient time to carry out the communications plan. Consider scheduling the effective date of the policy to coincide with the American Cancer Society's Great American Smoke-Out (November), World No Tobacco Day (May), or New Year's resolutions at the beginning of the year.
Promotion of the new tobacco free policy should begin at least two months before it takes effect. Periodic reminders should be sent to employees during the period leading up to the date the policy takes effect. One final announcement from the Commissioner or District Health Director should occur before the policy takes effect.
Creating a Supportive Environment Work with the Georgia Building Authority (GBA) and the DPH liaison to GBA to establish a consistent tobacco-free message. This would include removing cigarette receptacles located at the building entrances. Signage should be installed before the policy goes into effect and should be placed at all pedestrian entrances to notify both employees and visitors that they are entering a tobacco-free campus.
Enforcing & Monitoring the Policy In the weeks prior to the policy taking effect, DPH leadership should communicate to management their role in enforcing the policy, including specific guidance on how to correct non-compliances, procedures, and complaints. During the first few days after the policy has been implemented, have senior leadership walk through areas where employees have traditionally used tobacco.
After the policy has been implemented, carefully monitor feedback and any issues related to non-compliance or confusion. Clarify and adjust the policy when needed
References: Centers for Disease Control and Prevention (2010). Healthier Worksite Initiative HWI: Toolkits: Tobacco Implementation. Retrieved April 8 from http://www.cdc.gov/nccdphp/dnpao/hwi/toolkits/tobacco/
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GET CHECKED
Chronic diseases like heart disease and diabetes, by definition, develop over time and do not occur suddenly. Fortunately, early diagnosis can slow or halt the progression of disease and avert costly medical treatments, complications, diminished quality of life, and premature death. So it makes good sense that regular preventive checkups and assessments are among the most important steps your employees can take to detect health risks and problems and take interventional steps as early as possible.
The most common barriers to getting routine health assessments are inconvenience and cost. Employees may not have the time, transportation, financial means, or childcare support to allow them to visit a healthcare practitioner for appropriate screenings as often as they should. As an employer, you have the ability to make preventive assessments available to employees who may not have access to them otherwise. Here are some suggestions that will make it easier for your employees to "Get Checked":
Offer assessments as part of or in between health fairs
Offer programs that complement health assessments
Establish an on-site health clinic
Include preventive checkups as a wellness benefit
Offer assessments as part of or in between health fairs . . . Employee health fairs that include assessments can help your employees identify their risks of serious illness, or even the presence of the illness itself. You can begin working with local health professionals to conduct these assessments and provide follow-up counseling and intervention strategies for those identified as being at high-risk. Note that assessing or testing employees without appropriate follow up will not lead to appropriate care, reduction of risk, or management of condition identified. Consult Sections Five and Six for more resources on dealing with high-risk individuals.
Hints I Conduct an employee health fair that incorporates assessments appropriate for both men and women. Also consider a plan for including spouses and other dependents. I Use paper screening tools to assess employee risk. Those with higher risk should be referred for further evaluation by their health care provider. I Provide periodic health assessments in between full health fairs. This might take the form of an on-site assessment day each quarter, with a different test available at each session. You may also want to consider tying assessment events to health observances like Diabetes Alert Day and National High Blood Pressure Education Month. I Partner with other small businesses in your area to offer a health fair together, if you do not have the space, means, or number of employees to justify a health fair of your own.
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Offer programs that complement health assessments . . . It is imperative that health assessments be followed up with further evaluation, interventions, and disease management programs. Taking these steps goes a long way towards mitigating further health risk and complications from disease. When selecting disease management programs make sure that they offer more than just education, and include skill building.
Hints I Identify the disease management and behavior change resources available through your health insurance carrier(s). These may include online classes, self-help materials and curriculum, and nurse help lines. I Contact your local health service organization like the American Heart Association, American Cancer Society, and American Diabetes Association to learn what resources are available through them.
Establish an on-site health clinic . . . While some employees may give lack of time as a reason for not getting checked, on-site health clinics offer a way to address this. An on-site health clinic need not be a full-service health facility. It should however, be a place where employees can have access to services like health monitoring (blood pressure, blood glucose check), health education/consultation services, and first aid and triage care.
Hints I Small employers that do not have the space or cannot afford resources to hire a nurse on staff may consider pooling their resources together to secure the services of a visiting nurse dedicated to that employer group. I Consider the space you have available, perhaps converting a conference room or other space for use on "clinic days" when the visiting nurse is on-site. However, space should be appropriate for services provided. For example, an enclosed room should be used to ensure privacy during consultation. Also consider security and access issues related to recordkeeping. I Work with your local hospital or medical center. They can usually help with occupational health services including screening and disease management education. I Make sure to clearly define the role of nurses and other staff in health clinic with employers.
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Include preventive checkups as a wellness benefit . . . Benefit design offers another opportunity to encourage employees to get appropriate preventive health assessments. Consider including annual exams and other age-appropriate assessments at no cost to the employee. Doing so will remove the cost barrier and further encourage employees to Get Checked.
Hints I Work with your health insurance carrier(s) to promote this benefit to employees via various methods in person at benefits/enrollment events, electronic media, and/or mailings. I Also work with your health insurance carrier(s) to develop a plan where the information from health assessments can be used to categorize and direct employees to behavior change and disease management programs for employees. This must be done with privacy and confidentiality considerations, however. I Offer incentives tied to health plan. Examples include offering a premium or other credit to employees that complete an annual physical and/or health risk assessment questionnaire.
A Note about Clinical Guidelines
Preventive screenings can identify persons with a previously undiagnosed condition, or identify changes that suggest which person is at significantly higher risk for developing a condition. For persons at higher risk or who exhibit pre-disease conditions, early interventions directed at lifestyle changes may prevent the development of the condition, thus improving health outcomes and promoting cost savings. Those who are identified through screening tests as being at higher risk should visit their health care providers to schedule more thorough diagnostic tests.
American Caner Society www.cancer.org
American Diabetes Association www.diabetes.org
American Heart Association www.americanheart.org National Heart, Lung, and Blood Institute www.nhlbi.nih.gov/guidelines
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BE POSITIVE
The Cost of Depression Mental health and personal problems can spill over into professional lives, thus having a direct impact on job performance. While mental health related conditions are often dismissed, they have a direct and documented impact on employee absenteeism and job performance. According to the 1999 Surgeon General's Report on Mental Health, mental illness costs the nation $63 billion in lost productivity each year,16 which not only compromises on-the-job productivity, but also impacts the costs associated with staff turnover, managing employee conflicts, and increased accident rates. In fact, the Occupational Safety and Health Administration (OSHA) has declared stress a workplace safety hazard.
Depression in the workplace costs approximately $44 billion of lost productivity in both presenteeism and absenteeism.17 A report by the National Institute for Occupational Safety and Health (NIOSH) cites a survey in which 40% of employees reported that their jobs are "extremely stressful,"18 which can be a leading precursor of depression. In fact, according to the World Health Organization (WHO), depression is the second leading cause of disability in the United States for those 15-44 years of age.19 To understand the impact depression may have on your business or organization, consider using the Return on Investment (ROI) calculator for depression found at www.depressioncalculator.org.
Often, the root of mental health issues that affect the workplace can be summed up in one word: stress. It can affect people physically, emotionally and personally; certainly, it can also affect relationships. Excessive stress can lead to alcohol and/or substance abuse, including tobacco use, unhealthy and/or binge eating, sleeplessness, lack of energy, depression, and accidents. Stress is a major contributor to chronic diseases and can worsen symptoms. Stress can be triggered by any number of factors:
Major changes due to industry reorganizations, technological advancements, changes in job roles and responsibilities or workloads.
Personal illness or injury, achievement or disappointment, retirement.
Social changes such as the death of a loved one.
Financial changes due to major purchases such as buying a home, or additional family expenses due to a family illness or child care/educational expenses.
While employers cannot exert control or influence over many of these dynamics, it is in the best interest of every business and organization to take an honest account of stress levels in the work setting and take steps to minimize its effects. In fact, nearly 3 in 4 employees say that work is a significant source of stress and more than half of employees said they were less productive at work because of stress.20 Furthermore, it is estimated that job stress accounts for more than $300 billion a year in absenteeism, turnover, diminished productivity, and medical, legal and insurance costs.21
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Provide for work-life balance... Many employees are faced with challenges at and outside of work. Ever lengthening workdays and deadlines are followed by the responsibilities of being spouses, parents, and sometimes caretakers for elderly parents. It is quite easy for the demands of work and family to interfere with one another, create additional stress for employees, and negatively affect productivity. Fifty-two percent of employees say that their job demands interfere with family or home responsibilities, while 43% say that home and family responsibilities interfere with job performance.20 Scheduling changes and added benefits can be used to help employees achieve better balance between work and family. Some ideas include:
Hints I Allow employees the option of having flexible and alternative work schedules. I Offer teleworking options. Allowing employees to work from home or off-site eliminates the frustration of difficult commutes and the opportunity to complete the day's tasks with limited distractions. I Provide support for family demands. One major issue is childcare which can cause significant worry and lead to absences if employees cannot secure childcare. Consider benefits like on-site childcare, backup childcare, or childcare referrals. Also include support for other dependents like parents and relatives employees may be responsible for.
Change office culture for the better... Have you ever considered the culture at your office and how it may affect stress levels for employees? If you don't know what the culture is like or how it is affecting employees, check the pulse of your company. Are employees happy to come to work and do they feel their work matters? Do work assignments match skill level and are expectations clear? The top reasons employees stay with their employer are: exciting and challenging work; opportunities for career growth, learning, and development; high-quality co workers; fair pay; and supportive management.22 Things like communication, employee engagement, and appropriate workload go a long way to alleviate workrelated stress and increase employee morale. Creating a less stressful work environment requires a variety of strategies that target these and other culture factors.
Hints I Offer opportunities for employee engagement and involvement. For example, allow employees to provide input/feedback on company decisions that affect them. I Provide opportunities for employees to connect with each other. Develop forums and events where they can offer each other social support. These may take the form of company picnics and holiday parties. Remember however to offer healthy eating options at these events and perhaps even include a little physical activity. I Communicate with employees regularly and respectfully, particularly on matters that can create tension and added stress like organizational restructuring, mergers/acquisitions, job security, etc. I Implement an employee recognition program and reward employees for a job well done. Make sure that recognition is specific and timely. I Train managers and supervisors to recognize stress and its effects on employees. Also, train them to provide work assignments that are meaningful and better utilize employees' skills, while helping employees better handle workload.
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Offer stress management help Stress management programs can teach employees how to more effectively deal with stress by setting goals and applying techniques to diffuse unpleasant feelings. Such techniques might include positive imagery, visualization and controlled movement, and deep breathing exercises. A combination of these elements is often effective for most people. Employee access to counseling through worksite resources, such as an employee assistance program, and/or healthcare professionals should be included.
Hints I Hold lunch-and-learns or workshops on topics related to stress management: coping skills, relaxation techniques, deep breathing, and time management. Instead of stand-alone events, consider doing a stress management series so employees can gain and practice a variety of skills. I Implement an employee assistance program (EAP) or other counseling services. If you offer an EAP program, consider adopting an EAP policy that let's employees know that this confidential service is available. I Include coverage for mental health as part of your company's health benefits. I Share stress management tips via e-mail, bulletin boards, paycheck stuffers, etc. I Hold a "De-Stress Day" event and offer things like massage and other methods of relaxation. If you do not have a large budget for such an event, you may want to consider contacting a local massage therapy training program and have students offer 10-minute chair massages for employees.
Treat your "sick" building . . . The physical design and environment of your worksite is another way to improve employee health while reducing stress and improving mood. "Sick building syndrome" is a legitimate health concern and is used to describe when employees and other occupants experience symptoms of acute discomfort as a result of being in a building. Symptoms include headache; eye, nose or throat irritation; dry or itchy skin; dizziness and nausea. Sick building syndrome can be caused by poor ventilation, chemical contaminants, and biological contaminants (e.g. bacteria, mold, and pollen). Consider the following ways to make your office a "healthy office".
Hints I Identify sources of indoor pollution that can lead to stress. These include noise, overcrowding, and poor air quality. I Clear the air. Increase ventilation and air distribution to reduce indoor air pollutant levels. Also consider particle control devices like filters to remove small-particle irritants from the air. I Provide ergonomic furniture and workstations. Conducting an ergonomic assessment may be the first step to identify potential triggers of carpal tunnel syndrome, neck and back strain, etc. I Even if all employees can't have an office/cube with a view, consider adjustments to floor plans, window treatments, and lighting that would ensure sufficient lighting and limit glare.
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SECTION FOUR RESOURCES
Live Healthy Georgia Campaign - www.livehealthygeorgia.org LaLeche League International - http://lalecheleague.org/ Implementing a Tobacco-free Campus Initiative in Your Workplace. Available at: http://www.cdc.gov/nccdphp/dnpa/hwi/toolkits/tobacco/index.htm PEP: A Personal Empowerment Plan. Available at: http://www.cdc.gov/nccdphp/dnpa/pep.htm National Association for Health and Fitness - www.physicalfitness.org National Institute for Occupational Safety and Health - http://www.cdc.gov/niosh Occupational Safety and Health Administration - http://www.osha.gov/ National Recreation and Park Association. - www.nrpa.org National Health Observances. Available at: http://www.healthfinder.gov/nho/default.aspx
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Notes
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Section Five
FOCUS AREAS FOR HIGH-RISK EMPLOYEES
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FIVE
Focus Areas For High-Risk Employees
RISK REDUCTION
Individual health risk or, how likely a person is to develop heart disease, diabetes, cancer, obesity, and other chronic health conditions has been directly related to medical costs. Simply put, as health risks increase, medical costs also increase.23 Clearly, identifying employees at risk and focusing on intervention strategies can have a substantial financial impact on your bottom line! This section of the Work Healthy Georgia toolkit provides resources and ideas for identifying who is most at risk for developing a health condition, and what can be done to slow or halt the progression of disease.
Employers who choose to focus on risk reduction should be prepared to implement programs preferably on-site and on-the-clock that address the needs of those determined by health risk screenings to be high-risk, including strategies that help employees improve their health risk levels through behavior changes and lifestyle modifications. It is important to note that some individuals may not see significant improvements in their health due to existing predispositions, and others may simply choose not to modify their lifestyles.
Here are the steps you should take: Make adjustments to your company benefits package Follow recommendations to address common chronic diseases Develop an emergency response plan
Make adjustments to your company benefits package... Risk reduction should always be presented and implemented as a benefit to employees and their families. At the same time, it is recommended that the development of risk reduction strategies and programs be done in a way that integrates with other benefits offered at the worksite.
One of the primary ways to do this is to incorporate risk reduction into the worksite's overall benefits offerings. For example, an effective way to maximize participation is to incorporate risk reduction participation within the health plan through benefit differentials such as deductibles and/or maximum out-of-pocket limits or co-insurance levels. It is important to make sure that the strategy is tied only to participation and that it does not discriminate based on any individual's level of health, his or her medical condition, or any "results" related to health improvement.
Other benefits that can be incorporated into risk reduction include providing financial incentives (again, for participation only), time off, activities that are provided while employees are "on the clock," or any other award or recognition that a worksite feels might motivate individuals to actively engage and participate in risk reduction programs.
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CHRONIC DIESEASES
Follow recommendations to address common chronic diseases... Individuals with chronic health conditions should receive care that includes education about their health condition, appropriate medical treatment, and referral to self-management programs. Below are some recommendations and resources for selected common chronic diseases:
Individuals with chronic health conditions should receive care that includes education about their health condition, appropriate medical treatment, and referral to self-management programs. Below are some recommendations and resources for selected common chronic diseases:
Cardiovascular Disease Cardiovascular Disease accounts for one of three deaths in the United States each year. Strategies that address risk factors associated with cardiovascular disease, such as high blood pressure, cholesterol, and tobacco use can greatly reduce the burden of cardiovascular disease. 24
I Many of the risk factors for heart disease and stroke are preventable and can be controlled. Strategies related to employee health and worksite wellness initiatives can lead to cost savings for employers as well as improve health outcomes for employees.
I A review of 42 studies found that worksite wellness programs can lead to a reduction of more than 25% in absenteeism, healthcare costs, and disability/workers compensation costs.
I A comprehensive worksite wellness program address multiple factors and conditions, they have proven to be the most effective and support healthy lifestyles and prevent heart disease and stroke.
I Heart Disease and stroke can be prevented. Key recommendations for preventing heart disease and stroke include: Know your blood pressure and keep it under control Exercise regularly Don't use tobacco Know your cholesterol and triglyceride levels and keep them under control Eat fruits and vegetables Maintain a healthy weight
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Actions Employers Can Take: Align your employee health initiatives and programs with the Centers for Disease Control and Prevention's (CDC) Million Hearts goals. Examples include education programs, tobacco cessation programs, worksite wellness programs, and employee recognition programs. Pledge your organization's commitment and share your success stories on the Million Hearts website: http://millionhearts.hhs.gov Educate your employees. Create educational sessions or lunch and learns that educate employees about the importance of healthful living and risk factors associated with heart disease and stroke. Empower your employees to take control of their health. Include clinical preventative services for your employees. Include recommended coverage for preventative services, e.g., blood pressure and cholesterol screening, treatment, and control, tobacco cessation, and healthy eating as a component of your benefits package. Support worksite policies that discourage tobacco use and support healthier food options. Distribute information on signs and symptoms of heart attack and stroke. This can be done through posters, email bulletins, pay stub messages, and other communication vehicles. See the American Heart Association website: www.amerianheart.org Provide opportunities for screening and identify employees at risk for cardiovascular disease. The National Heart, Lung, and Blood Institute has on online resources on their website: www.nhlbi.nih.gov Provide opportunities for physical activity and make heart-healthy foods available on-site for all employees, particularly those at risk for developing cardiovascular disease. Post signs and informational materials on the signs and symptoms for heart attack and stroke. Assess your worksite wellness program by downloading the Center for Disease Control and Prevention's Worksite Health Scorecard. This tool allows employers to assess their program and prioritize approaches to health promotion.26 The scorecard can be downloaded from www.cdc.gov/dhdsp/pubs/worksite_scorecard.htm
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From the Million Hearts Action Steps for Employers26:

Select High-Impact Strategies for Cardiovascular Health Promotion

Actions

High Blood Pressure and Cholesterol Management

Provide health insurance coverage with no or low out of pocket costs for cholesterol/lipid control medications, blood pressure control medication, or for home blood pressure monitoring devices. 27, 28
Provide one-on-one or group lifestyle counseling and follow-up monitoring for employees with high blood pressure, pre-hypertension, or high cholesterol.

Tobacco Control

Provide health insurance coverage with nor or low-out-of-pocket costs for prescription tobacco cessation medications, including nicotine replacement.

Nutrition

Make most (more than 50%) of food and beverage choices available in vending machines, cafeterias, snack bars, or other purchase points be healthier food items.
Subsidize or provide discounts on healthier foods and beverages offered in vending machines, cafeterias, snack bars, or other purchase points.

Physical Activity

Provide environmental supports for recreation or physical activity (e.g., onsite exercise facility, subsidized or discounted onsite or offsite exercise facilities walking trails, bicycle racks).
Provide organized individual or group physical activity programs for employees (e.g., walking or stretching programs, group exercise, or weight training).

Diabetes
I Hold worksite educational programs for people with diabetes and those at risk. See Diabetes at Work at www.diabetesatwork.org.
I Screen for those at risk for diabetes using the American Diabetes Association's "Take the Test. Know Your Score," followed by referral to a physician for individuals whose scores are over 10. The diabetes risk test is available online at Diabetes Risk Test: http://www.diabetes.org/diabetes-basics/prevention/diabetes-risk-test/
I Provide incentives, such as reduction in co-pay, for medications and testing supplies for individuals who keep their Hemoglobin A1c rate <7% (used to determine blood sugar control).
I Provide nutrition and physical activity training, as well as opportunities for physical activity, for all staff, especially those at risk for diabetes.
I Encourage individuals with diabetes to monitor their blood glucose levels regularly.

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Cancer I Promote inclusion of existing cessation services, including the Georgia Tobacco Quit Line, in employee assistance and training programs. I Participate in the Great American Smokeout. Visit the American Cancer Society website for more information at www.cancer.org. I Distribute appropriate screening guidelines for breast, cervical, prostate, and skin cancer. This can be accomplished through email, brochures, posters, and other communication vehicles. Resources and materials are available at the American Cancer Society and other cancer prevention organizations. I Provide information for free breast and cervical cancer screening for eligible women through Georgia's Breast and Cervical Cancer Program. Access to these screening services is available through local county health departments.
Asthma I Provide information on occupational asthma. Learn more at www.lungusa.org. I Have employees with asthma take the Asthma Control Test at www.asthmacontrol.com/. I Eliminate secondhand smoke. Visit www.cdc.gov/tobacco/ETS_Toolkit/worksites/intro.htm. I Learn more about indoor air quality in the workplace. Visit www.epa.gov/iaq/is-build2.html I Eliminate environmental triggers at the workplace. Visit www.epa.gov/asthma/triggers.html.
Arthritis I Share information and resources on arthritis management. See the Arthritis Foundation for more information at www.arthritis.org. I Make accommodations available for those with arthritis (as required under the Americans with Disabilities Act). I Invest in ergonomic furniture and equipment.
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EMERGENCY RESPONSE Develop an emergency response plan... Employees should know what to do when a co-worker has a medical emergency. All worksites should have a formal, defined, and written emergency response plan (ERP) for each location and should communicate it to all employees. A defined and written ERP, including formal employee training, will not only benefit high-risk individuals within the worksite, but potentially those who are not at risk, should an event occur. A worksite's training and preparation can significantly improve outcomes if the right questions and concerns have been addressed beforehand and employees are ready to respond. Among others, here are some appropriate questions that should be addressed within an ERP:
Are automated external defibrillators (AEDs) readily available if someone suffers a heart attack? Have employees been trained how to use them? If not, have any employees been trained to administer cardiopulmonary resuscitation (CPR) or other life-saving measures?
Are first aid kits accessible throughout the worksite's facilities? Do employees know what the kits contain and how to use the contents?
Do employees know the appropriate medical emergency response numbers to call in case of emergency (9-1-1 or another specific number if that is not available)? Is the number prominently posted throughout the worksite?
Have staff assignments been made that specify who manages the use of AEDs and/or first aid kits, who calls for medical assistance, and who is positioned in the most appropriate place to direct emergency responders upon arrival?
Have employees been identified to serve as "emergency captains" to coordinate evacuations? Have employees who require additional assistance in case of evacuation been identified, and is support in place to give them additional time to exit?
Do employees know how to recognize and respond appropriately to an individual experiencing an asthma attack or severe drop in blood glucose? Do employees know where medications are kept and how to administer them?
The American Heart Association supports implementing the "chain of survival" to rescue people who suffer a cardiac arrest in the community. The adult chain consists of early recognition of the emergency and activation of emergency response system (phone 9-1-1 immediately), early CPR, early defibrillation, and early advanced care.
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Focus Areas For High-Risk Employees
Emergency Response for High-Risk Individuals Part of an emergency response plan (ERP) should include preparations for assisting and accommodating high-risk individuals during overall emergencies at the worksite. It is important to note that this applies to both medical emergencies and non-medical emergencies. While information about an individual's health risk should not be common knowledge unless the individual has specifically shared it with others, worksites should be prepared to address specific concerns with high-risk individuals and integrate appropriate actions into their ERP if requested or needed.
Part of the ERP should also address how to react should an employee experience an "event" such as a heart attack or stroke. While employees may not be aware of the health risk levels of their co-workers, they should still be prepared to implement pre-defined strategies for emergencies if the need arises.
The Importance of the Automatic External Defibrillator (AED) More than 250,000 sudden cardiac deaths occur each year among persons who may or may not have a previous diagnosis of heart disease. And unfortunately, CPR alone cannot fully restore blood flow nor restore heart rhythm. Only electric shock can do that and prompt electric shock treatment can mean the difference between life and death for an employee who experiences abrupt and sudden loss of heart function. According to the American Heart Association, a person suffering cardiac arrest literally has minutes to live, and responding with an Automatic External Defibrillator or AED within those minutes can mean the difference between life and death! In fact, it has been documented that an AEDs in the hands of a properly trained operator can save 50,000 of the 250,000 lives lost annually to sudden cardiac death events,29 many of which occur in the workplace.
An AED is a portable electronic device that automatically diagnoses a potentially life-threatening cardiac arrhythmia, or heart attack, and applies electrical shock to stop the arrhythmia and allow the heart to start beating normally again. About the size and weight of a small laptop computer, AEDs do not require much maintenance. They are easy to use with simple audio and/or visual prompts although training is recommended and are pre-programmed to administer shock only when necessary. AEDs are also very affordable at about $1500 to $2000 per unit and are rapidly becoming a staple in public facilities throughout the country.
The AED
Purpose: Quickly and effectively restore heartbeat and blood flow. Who: Non-medical and minimally trained personnel. Why: CPR alone cannot fully restore blood flow and does not restore heart rhythm. Where: Onsite (office, warehouse, retail operation, camp, daycare facility, etc.) How: Small portable automated external defibrillator units. When: Immediately following sudden cardiac arrest.
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SECTION FIVE RESOURCES
American Heart Association - www.americanheart.org American Cancer Society - www.cancer.org Arthritis Foundation - www.arthritis.org American Diabetes Association - www.diabetes.org Barnett E, Anderson T, Blosnich J, Menard J, Halverson J, Casper M. Heart Healthy and Stroke Free: A Social Environment Handbook. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2007. Available at: http://www.cdc.gov/dhdsp/seh_handbook.htm Centers for Disease Control and Prevention. Making a Difference-The Business Community Takes on Diabetes. Atlanta, Georgia: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1999. Available at: http://www.ndep.nih.gov/diabetes/pubs/MakingDifference.pdf Diabetes General Assessment Tool for Businesses. Available at: http://www.diabetesatwork.org/diabetesatwork/GettingStarted/AssessmentTool_General.cfm
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Notes
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Section Six
SAMPLES, TOOLS, AND OTHER RESOURCES
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WORK HEALTHY GEORGIA WELLNESS ASSESSMENT TOOL Assessing Worksite Support for a Healthy Lifestyle
The Work Healthy Georgia Wellness Assessment Tool has been designed to help you collect information about your company and its policies and practices. This is a needs assessment to help your organization inform, educate, and improve the health of you and your employees. It will provide information to guide your decisions about the best ways to create a work environment and culture that encourage your employees to strive for better health.

Company Demographics

1. Is your company self-insured for employee health and medical benefits? J Yes J No

2. Approximately how many employees work for your company?

J

< 15

J

250 - 499

J

15-99

J

500 - 999

J

100 - 249

J

> 1000+

3. Approximately what percentage of your company's workforce is full-time?

J

Less than 25%

J

51-75%

J

26-50%

J

76-100%

4. Approximately what percentage of your company's workforce is female?

J

Less than 25%

J

51-75%

J

26-50%

J

76-100%

5. Approximately what percentage of your company's workforce is racially white?

J

Less than 25%

J

51-75%

J

26-50%

J

76-100%

6. Approximately what percentage of your company's workforce is under age 50?

J

Less than 25%

J

51-75%

J

26-50%

J

76-100%

7. Does your company have more than one work shift? J Yes J No

8. What percentage of your employees can be classified as manual labor?

(Example: factory line workers, farm hands, technicians, constructions workers, etc)

J

Less than 25%

J

51-75%

J

26-50%

J

76-100%

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WORK HEALTHY GEORGIA WELLNESS ASSESSMENT TOOL Assessing Worksite Support for a Healthy Lifestyle
Please check the box that corresponds to your response ("Yes" or "No"). At the end of each section, total the number of "yes" responses and write down your subtotal.

Wellness Program

1.

Does your company's mission statement include a reference to improving and maintaining employee health?

Yes No

2.

Does your company belong to any national or state-level organized employer effort to improve employee health?

3. Does your company belong to a local wellness coalition or health council?
Does your company have an officially recognized worksite wellness or health 4. promotion program open to all full-time employees?

Does your company have a health or safety committee or other group that has 5. worksite wellness as part of its scope of work and meets regularly?

Does your company employ a person full-time whose primary responsibility is the 6. delivery of health promotion/wellness programs? (Example: nurse, dietitian, fitness
instructor, wellness coordinator)

Does your company budget or allocate funds for employee health and 7. wellness?

Does your company offer any incentives, financial or otherwise, to employees who 8. participate in health promotion, wellness, or disease screening programs?

Does your company publicly recognize or honor employees who promote or 9. champion health and wellness to their colleagues?

During the past 12 months, has your company worked with your local health department, hospital, or health advocacy organization, such as the American Heart 10. Association, to develop and implement any worksite wellness or health promotion events or programs?

During the past 12 months, did your company conduct any health fairs or other one11. day health educational events including health observances like Wear Red for Women
Day and Diabetes Alert Day?

Has your company ever assessed employees' knowledge, attitudes, skills, and/or 12. habits related to health behaviors and wellness?

Does your company track employee participation in company-sponsored worksite 13. wellness or health promotion programs or activities?

Do you measure participant changes in health or fitness status to verify the 14. effectiveness of your programs?

15. Does your company formally evaluate your wellness program or activities?

Wellness Program Subtotal

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WORK HEALTHY GEORGIA WELLNESS ASSESSMENT TOOL Assessing Worksite Support for a Healthy Lifestyle
Please check the box that corresponds to your response ("Yes" or "No"). At the end of each section, total the number of "yes" responses and write down your subtotal.

Nutrition
Does your company's primary worksite have a cafeteria, vending machines, or other 1. access to healthy food during working hours (i.e. foods that are low fat, low-sodium,
high-fiber, fruits, vegetables, water)?

Yes No

Does your company have a written policy that makes healthy food choices available in 2. your cafeteria and/or vending machines?

3.

Are foods and beverages in the cafeteria and vending machines labeled with nutritional information or designated as "healthy" choices?

Are healthy options like fruit, whole grain breads, granola bars, and water available at 4. company meetings and events?

5. Does your worksite have a break room with a refrigerator and microwave?

6.

Does your company have a written policy that permits breastfeeding women to take time off during working hours to express or pump breast milk?

7.

Does your company's primary worksite have a designated area for breastfeeding mothers that offers privacy to express breast milk and refrigerated storage for bottles?

8.

During the past 12 months, did your company provide on-site breastfeeding support or education programs, and/or promote community-based breastfeeding support?

9.

During the past 12 months, did your company provide or promote on-site nutrition education or weight management programs?

During the past 12 months, did your company subsidize employees' participation in 10. community nutrition education programs such as Weight Watchers?

11. Does your company have any signs or pictures posted around the worksite to encourage workers to eat healthier foods?

12. Does your company distribute information to workers in company newsletters, e-mails or other mailings about the importance of eating healthier foods?

Nutrition Subtotal

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WORK HEALTHY GEORGIA WELLNESS ASSESSMENT TOOL Assessing Worksite Support for a Healthy Lifestyle
Please check the box that corresponds to your response ("Yes" or "No"). At the end of each section, total the number of "yes" responses and write down your subtotal.

Physical Activity

Yes No

1.

Does your company's primary worksite have on-site fitness facilities available to employees?

2. Does your company offer fitness classes on-site (such as yoga, aerobics, stretching)?

Does your company subsidize employees' memberships in health clubs/gyms in the 3. community?

Does your company have a policy that allows employees to engage in physical activity
4. during paid work time? (Example: participate in walking groups or fitness classes, use on-site fitness facility, etc.)

5. Does your worksite promote use of walking trails, bicycle racks or stairs?

Does your company provide any other accommodations such as showers and
6. changing rooms to support physical activity at work during break times or in commuting to work?

7. Does your company organize or sponsor employee walking groups?

During the past 12 months, has your company participated in or sponsored a corporate 8. fitness challenge, physical activity event, and/or sports team for employees?

Does your company have any signs or pictures posted around your worksite to 9. encourage workers to be more physically active?

10.

Does your company distribute information to workers in company newsletters, e-mails or other mailings about the importance of being physically active?

Physical Activity Subtotal

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WORK HEALTHY GEORGIA WELLNESS ASSESSMENT TOOL Assessing Worksite Support for a Healthy Lifestyle
Please check the box that corresponds to your response ("Yes" or "No"). At the end of each section, total the number of "yes" responses and write down your subtotal.

Tobacco

1.

Does your company have a written policy restricting use of all tobacco products onsite?

Yes No

2.

Does your company's primary worksite have a designated area for smoking that is enclosed and has signage posted according to the Georgia Smokefree Air Act of 2005?

3.

Does your company ban the sale of cigarettes and other tobacco products on-site (vendors, vending machines, etc.)?

4.

During the past 12 months, did your company provide or promote on-site smoking cessation programs?

5.

During the past 12 months, did your company subsidize employee's participation in community smoking cessation programs?

6.

Does your company have any signs or pictures posted around your worksite to encourage workers to stop tobacco use?

Does your company distribute information to workers in company newsletters, e-mails 7. or other mailings about the health effects of tobacco use and the importance of
cessation?

Tobacco Subtotal

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WORK HEALTHY GEORGIA WELLNESS ASSESSMENT TOOL Assessing Worksite Support for a Healthy Lifestyle
Please check the box that corresponds to your response ("Yes" or "No"). At the end of each section, total the number of "yes" responses and write down your subtotal.

Screening & Disease Management

1. Does your company's health benefits package include coverage for preventive clinical services?

Does your company's health benefits package include coverage for disease 2. management services for persons with chronic diseases such as diabetes?

Does your company have health care professionals on-site or partner with any health 3. care agency or provider to offer screenings and disease management services (blood
pressure check, blood sugar check, cholesterol check, medication checks, etc.)?

4.

Are employees permitted to have health monitoring devices (blood pressure and glucose monitors) and medications on their person or on-site?

5. Does your company offer health risk assessments to employees?

6.

Does your company require all full-time employees to be screened for chronic diseases such as heart disease or diabetes?

7.

Does your company require employees identified as high risk for chronic diseases to participate in disease management programs?

8.

Does your company offer web-based, telephonic, or in-person health counseling or clinical management of chronic diseases?

During the past 12 months, did your company support or offer on-site any voluntary

9.

disease prevention or screening services (such as blood pressure screening, blood sugar testing, on-site flu shots, depression screenings, etc.)?

During the past 12 months, did your company provide any educational programs on 10. any specific chronic disease such as cancer, diabetes, or heart disease?

11.

Does your company have any signs or pictures posted around your worksite to encourage workers to get checked regularly for chronic diseases?

Does your company distribute information to workers in company newsletters, 12. e-mails or other mailings about the importance of getting checked regularly for
chronic diseases?

Screening Subtotal

Yes No

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WORK HEALTHY GEORGIA WELLNESS ASSESSMENT TOOL Assessing Worksite Support for a Healthy Lifestyle
Please check the box that corresponds to your response ("Yes" or "No"). At the end of each section, total the number of "yes" responses and write down your subtotal.

Stress

Yes No

1. Does your company offer an employee assistance program (EAP)?

Does your worksite have a lounge or other area where employees can go to take a 2. break or practice relaxation exercises?

3.

Does your company subsidize employees' use of counseling and/or mental health services?

During the past 12 months, has your company offered any of the following programs to 4. employees: stress management, violence prevention, caregiver support, and alcohol or
drug abuse prevention education?

5. Does your company have any signs or pictures posted around your worksite to encourage workers to manage stress?

6. Does your company distribute information to workers in company newsletters, e-mails or other mailings about the importance of stress management?

Stress Subtotal

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WORK HEALTHY GEORGIA WELLNESS ASSESSMENT TOOL Assessing Worksite Support for a Healthy Lifestyle
Please check the box that corresponds to your response ("Yes" or "No"). At the end of each section, total the number of "yes" responses and write down your subtotal.

Emergency Response

Yes No

1. Does your company have an emergency response plan that includes provisions for those with chronic diseases like heart disease and diabetes?

2.

Does your company have designated emergency coordinators who help direct employees in the event of an emergency and/or evacuation?

3.

Do employees have onsite access to a health professional (physician, nurse, other) and/or a health care facility or clinic for immediate treatment of health problems or

injuries?

4. Are policies in place for new employee orientation regarding emergency/evacuation procedures?

5.

Are signs prominently displayed at your company's worksites explaining how and when to make an emergency call (9-1-1)?

6.

Does your company offer training to employees on cardiopulmonary resuscitation (CPR) and/or first aid?

7. Do employees have access to first aid kits in prominent and well-marked locations?

8.

Is there at least one automated external defibrillator (AED) present at your company's primary worksite in a prominent and well-marked location?

Does your company have any signs or pictures posted around your worksite to 9. encourage workers to be aware of the warning signs and symptoms of heart attack,
stroke, or diabetes?
Does your company distribute information to workers in company newsletters, e-mails or 10. other mailings about the importance of being aware of warning signs and symptoms of
heart attack, stroke, or diabetes?

Emergency Response Subtotal

Section
Example Wellness Program Nutrition Physical Activity Tobacco Screening Stress Emergency Response
TOTAL

Subtotal 15

Out of
20 15 12 10
7 12
6 10
72

Percent Score 15 / 20 x 100 = 75%

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INTERPRETING YOUR RESULTS
Your responses to the survey should be used as a guide in making decisions on how to tailor your worksite wellness program and prioritize your efforts. When designing your program, make sure that wellness policies and environmental supports are included because they contribute to the program's sustainability and affect more individuals.
Here are some additional recommendations in interpreting your results: I Pay particular attention to diseases and conditions that are more prevalent in ethnic minorities, like diabetes and cardiovascular disease, and offer educational programs such as Diabetes at Work.
I For your female employees, include mammograms in health screening events or as part of your health benefits package.
I If you have a lot of older employees, keep in mind that the risk of certain conditions like arthritis, osteoporosis, and cardiovascular disease increases with age and offer programs and events that are specific to them.
I Be sure to implement program components from which all employees, irrespective of shift, employment status, position, etc., can benefit.
I Employees who can be classified as "manual labor" are particularly vulnerable to injuries that stem from repetitive motion. In planning your wellness program, include occupational safety and ergonomics, and allow time for stretch and fitness breaks.
I Demonstrate commitment to your wellness program by allocating resources to it both monetary and human resources.
I Identify resources in your community that can be used as part of your program. These include local hospitals, health service/advocacy organizations, parks, and health departments.
I Plan to do some type of evaluation or analysis of your wellness program. It is important to document the success of the program as a whole, as well as individual health achievements.
I Incentives and recognition (awards, honorable mentions, etc.) are important in gaining employee interest and maintaining participation in your wellness program.
Eat Healthy I Work with food service vendors to offer healthy eating options to employees in the cafeteria and vending machines and at meetings and events.
I Help employees identify healthy options by designating them with color-coded stickers or other symbols so they can be easily identified.
I Allow lactating moms time and a comfortable and private space to express breast milk.

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Be Active I Create opportunities for and allow your employees time to engage in physical activity during work hours. I Start a company walking group. No fancy equipment is needed and you can even do loops around the building. I If you have stairs, encourage employees to take the stairs to meetings.
Be Smoke-Free I Create a company tobacco-free policy and enforce it. I Provide smoking cessation support and services for employees who want to quit.
Get Checked I Instead of a traditional health fair, offer yearly health screenings to employees on-site. I Provide disease management services to employees that have or are at high risk for developing chronic diseases. Identify resources in your community that can help.
Be Positive I Offer employees opportunities for stress relief. I Consider having sessions on positive thinking and relaxation techniques. I Include provisions for employees who are on medication or need medical assistance in your emergency response plan. I Make sure that employees are clear on their roles and responsibilities during an emergency.

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LACTATION SUPPORT FOR GEORGIA EMPLOYERS
Getting Started
1. Start Small Begin A Pilot Project Many companies with successful lactation programs start small, with a simple pilot project, which can grow to meet employee needs and interest. For example, a simple lactation space can be the start of a program that can later add other components such as education materials, flexible break options, lactation support, and additional amenities or lactation rooms. Most employers who have set up a simple lactation space have reported reaping significant benefits in employee satisfaction and retention.
2. Gain Buy-In From Colleagues Front-line supervisors and managers play an important role as partners to human resources in creating a support environment for employees. Help to assure concerned team members that a breastfeeding friendly environment is cost effective and that the nominal costs help the company achieve its business goals. The Business Case for Breastfeeding provides clear evidence of the value of a lactation support program.
3. Assess The Need For A Lactation Program Assessing the needs of your employees can help with the justification and support for a lactation program and assist in the planning process. Include such questions as:
How many women are likely to be affected by a lactation support program? What department should be responsible for your programs oversight? How should space be allocated for a lactation room? What resources are available to equip the lactation room? What program policies should be developed? What type of recordkeeping may be required by the company? Where should promotional materials be placed to reach potential users of the lactation
program?
4. Determine A "Home" For Your Program Most employers establish an "administrative home" for their lactation program within human resources, aligning it with other departmental services such as:
Employee health benefits Employee wellness or health programs Existing family and work-life programs
5. Convene A Committee Or Task Force Many employers convene a committee or task force made up of key company stakeholders and knowledgeable experts from the company and the community, such as health professionals and lactation consultants. The committee or task force can help identify resources for your lactation program, such as equipment and policy development.
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6. Identify Community Resources A variety of community experts can also be brought into the committee or task force to assist in designing a program and lactation policy that will address the needs of your company and employees. These community experts can provide direct services to your breastfeeding employees:
Health Professionals: Professionals from hospitals, obstetric and pediatric care programs can provide valuable insight and health related information
Lactation Consultants: An International Board Certified Lactation Consultant (IBCLC) is a credentialed health professional who can provide direct breastfeeding education and clinical counseling for breastfeeding mothers. Some consultants can assist employers with establishing appropriate accommodations for lactating employees.
WIC: The United States Department of Agriculture Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides a nationwide system of nutritionists and breastfeeding support professionals and paraprofessionals. Many WIC programs are committed to providing community-based assistance to improve the environment for working mothers and can assist with providing resources. Some WIC programs may even be able to provide breast pumps for eligible employees.
Breastfeeding Coalitions: The mission of the Georgia Breastfeeding Coalition is to improve and maintain the health of Georgia families by protecting, supporting, and promoting breastfeeding. In Georgia, there are over ten local breastfeeding coalitions. The Georgia Breast feeding Coalition can often assist companies with implementing lactation programs.
La Leche League International: La Leche is a mother-to-mother support program that provides breastfeeding support groups and knowledgeable volunteers who offer telephone and one-on-one assistance to new mothers. Local leaders may be available to teach classes or assist worksites with guidance on how to support lactating mothers.
Insurance Carriers: Check with insurance carriers to identify policies and benefits for breastfeeding employees. Insurance companies may cover breastfeeding resources and services such as breast pumps, consultations with a lactation consultant, and breastfeeding supplies.
Additional Organizations: You may also find resources available from:
The March of Dimes
Healthy Mothers Healthy Babies Coalition
Healthy Start Initiatives
Local Hospitals
Local Chambers of Commerce
(Source: Adapted from the Business Case from Breastfeeding Easy Steps to Supporting Breastfeeding Employees)
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LACTATION SUPPORT FOR GEORGIA EMPLOYERS
Break Time for Nursing Mothers under FFLSA The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010 (P.L. 111-148). This law amended Section 7 of the Fair Labor Standards Act (FLSA).
General Requirements Employers are required to provide "reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child's birth each time such employee has need to express the milk." Employers are also required to provide "a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk."
The FLSA requirement break time for nursing mothers to express breast milk does not preempt State laws that provide greater protections to employees (for example, providing compensated break time, providing break time for exempt employees, or providing break time beyond 1 year after the child's birth).
Time and Location of Breaks Employers are required to provide a reasonable amount of break time to express milk as frequently as needed by the nursing mother. The frequency of breaks needed to express milk as well as the duration of each break is likely to vary.
A bathroom, even if it is private, is not permissible under the Act. The location provided must be functional as a space for expressing breast milk. If the space is not dedicated to the nursing mother's use, it must be available when needed in order to meet the statutory requirement. A space temporarily created or converted into a space for expressing milk or made available when needed by the nursing mother is sufficient; provided that the space is shielded from view, and free from intrusion from co-workers and the public.
Coverage and Compensation Only employees who are not exempt from Section 7, which includes FLSA's overtime pay requirements, are entitled to breaks to express milk. While employers are not required under the FLSA to provide breaks to nursing mothers who are exempt from the requirements of Section 7, they may be obligated to provide such breaks under State laws.
Employers with fewer than 50 employees are not subject to the FLSA break time requirement if compliance with the provision would impose an undue hardship. Whether compliance would be an undue hardship is determined by looking at the difficulty or expense of compliance for a specific employer in comparison to the size, financial resources, nature, and structure of the employer's business. All employees who work for the covered employer, regardless of the work site, are counted when determining whether this exemption may apply.

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Employers are not required under the FLSA to compensate nursing mothers for breaks taken for the purpose of expressing milk. However, where employers already provide compensated breaks, an employee who uses that break time to express milk must be compensated in the same way that other employees are compensated for break time. In addition, the FLSA's general requirement that the employee must be completely relieved from duty or else the time must be compensated as work time applies.
FLSA Prohibitions and Retaliation Section 15(a)(3) of the FLSA states that it is a violation for any person to "discharge or in any other manner discriminate against any employee because such employee has filed any complaint or instituted or caused to be instituted any proceed under or related to this Act, or has testified or is about to testify in any such proceeding, or has served or is about to serve on an industry committee."
Employees are protected regardless of whether the complaint is made orally or in writing. Complaints made to the Wage and Hour Division are protected, and most courts have ruled that internal complaints to an employer are also protected.
Any employee who is "discharged or in any manner discriminated against" because, for instance, he or she has filed a complaint or cooperated in an investigation, may file a retaliation complaint with the Wage and Hour Division or may file a private cause of action seeking appropriate remedies including, but not limited to, reinstatement, lost wages, and an additional equal amount as liquidated damaged.
Georgia Code Labor and Industrial Relations Title 34, Section 34-1-6 (a) As used in this Code section, the term `employer' means any person or entity that employs one or more employees and shall include the state and its political subdivisions.
(b) An employer may provide reasonable unpaid break time each day to an employee who needs to express breast milk for her infant child. The employer may make reasonable efforts to provide a room or other location (in close proximity to the work area), other than a toilet stall, where the employee can express her milk in privacy. The break time shall, if possible, run concurrently with any break time already provided to the employee. An employer is not required to provide break time under this Code section if to do so would unduly disrupt the operations of the employer.

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Feedback Form For Supervisors of Breastfeeding Employees As a company we provide a lactation support program to assist breastfeeding employees with providing milk for their infants. We value your feedback on ways the program can continue to improve to meet the needs of all of our employees.
Position/Title______________________________________________________________________________
Department_______________________________________________________________________________

1. How many colleagues or employees under your supervision are you aware of who are currently utilizing the company lactation support program?__________

2. Have you attended an employee orientation or training event on the program? __ Yes __ No

3. How do you feel the following lactation program components have impacted the BREASTFEEDING EMPLOYEE(S)?

Availability for a lactation room for milk expression

3. Positive Impact

2. No Impact Observed

1. Negative Impact

Opportunity to breastfeed baby at work

3. Positive Impact

2. No Impact Observed

1. Negative Impact

Flexible milk breaks 3. Positive Impact

2. No Impact Observed

1. Negative Impact

Flexible return to work policy (ex: part-time, job sharing, telecommuting, etc.)

3. Positive Impact

2. No Impact Observed

1. Negative Impact

Worksite education opportunities such as prenatal classes and monthly support groups

3. Positive Impact

2. No Impact Observed

1. Negative Impact

Other: ____________________________________________________________________________

3. Positive Impact

2. No Impact Observed

1. Negative Impact

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4. How do you feel these same components impact the operation of your DEPARTMENT?

Availability for a lactation room for milk expression

3. Positive Impact

2. No Impact Observed

1. Negative Impact

Opportunity to breastfeed baby at work

3. Positive Impact

2. No Impact Observed

1. Negative Impact

Flexible milk breaks 3. Positive Impact

2. No Impact Observed

1. Negative Impact

Flexible return to work policy (ex: part-time, job sharing, telecommuting, etc.)

3. Positive Impact

2. No Impact Observed

1. Negative Impact

Worksite education opportunities such as prenatal classes and monthly support groups

3. Positive Impact

2. No Impact Observed

1. Negative Impact

Other: ____________________________________________________________________________

3. Positive Impact

2. No Impact Observed

1. Negative Impact

5. Please describe what you feel works BEST about the company's lactation support program. _________________________________________________________________________________________

6. Please describe what may NOT be working well about the company's lactation support program. _________________________________________________________________________________________ 7. What suggestions or ideas do you feel would help improve the program? _________________________________________________________________________________________
Other comments: _________________________________________________________________________________________ _________________________________________________________________________________________ (Source: Adapted from the Business Case from Breastfeeding Easy Steps to Supporting Breastfeeding Employees)

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PROGRAM PLAN
Copy the table below for each objective and use it to help build your program plan. For each objective, you should identify:
Activity involved Person or persons responsible Timeframe for accomplishing the objective What measurable outcome is expected

Objective: __________________________________________________________________________

Activities

Persons Responsible (include partners)

Timeline

Performance Measurement

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SAMPLE BUDGET

Item Description
Walking trail - Sidewalk chalk, ribbons, and flags
Colorful Choices program kit

Cost
(per unit price x units needed)
$150.00
$130.00

Colorful Choices participant log form 100 @ 0.70 = $70.00

Incentives - pedometers Total

100 @ $5.00 = $500 $850.00

Justification
These materials will be used to mark off a walking route around the perimeter of the building.
Coordinator kit for the 20-day nutrition education program.
Participant log forms so employees can record and monitor their healthy eating.
Provide pedometers to all employees so they can track their daily physical activity.

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Item Description

BUDGET
Cost
(per unit price x units needed)

Justification

SIX

Total 90

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SAMPLE PROGRAM EVALUATION SURVEY
Thank you for attending today's presentation. Please let us know what you think about the presentation by completing this survey. Thank you!

Please rate how much you agree with the following statements by checking the most appropriate answer.

Strongly Disagree

Disagree

Neither Disagree or Agree

Agree SAtrgornegely

1. I understand what it means to be healthy

J

as a result of this presentation.

2. I understand why making healthy choices is

J

important.

3. I can explain factors on how to make my lifestyle

J

more healthy.

4. I can describe the different consequences

J

of making harmful choices.

J

J

J

J

J

J

J

J

J

J

J

J

J

J

J

J

5. What new things did you learn today? _____________________________________________________________________________________________ _____________________________________________________________________________________________ 6. What did you like most about the presentation? _____________________________________________________________________________________________ _____________________________________________________________________________________________ 7. What did you like least about the presentation? _____________________________________________________________________________________________ _____________________________________________________________________________________________ 8. Overall, how useful was this presentation to you? _____________________________________________________________________________________________ _____________________________________________________________________________________________ 9. Please list any questions, concerns, or comments you may have. _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

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HEALTH BEHAVIOR SURVEY
We are considering establishing a workplace wellness program and would like to hear your thoughts on the subject. Your input is extremely important to us.
Please take a few moments to answer these brief questions. Thank you!

Check the box that best applies to you OR fill in the blank as appropriate.

1. Would you say that in general your health is

Excellent

Very good

Good

Fair

Poor

2. When you are at work, which of the following best describes what you do?

Mostly sitting or standing

Mostly walking

Not Applicable

Mostly heavy labor or physically demanding work

Don't know/Not sure

3. During the past month, other than your regular job, how often did you participate for at least 10 minutes in any physical activities that increased your heart rate or your breathing, such as running, calisthenics, golf, gardening, bicycling, stair climbing, or walking for exercise? _______ Per day _______ Per week _______Per month Never Don't know/Not sure

4. During the past month, how often did you do physical activities specifically designed to strengthen your muscles and bones, such as lifting weights, push-ups or pull-ups? _______ Per day _______ Per week _______Per month Never Don't know/Not sure

5. During the past month, how often did you do physical activities specifically designed to improve your flexibility, such as yoga, stretching, or other range-of-motion movements? _______ Per day _______ Per week _______Per month Never Don't know/Not sure

6. During the past month, how often did you drink fruit juices or eat fruit? _______ Per day _______ Per week _______Per month Never Don't know/Not sure

7. During the past month, how often did you eat green salad or vegetables other than potatoes? _______ Per day _______ Per week _______Per month Never Don't know/Not sure
8. During the past month, how often did you eat foods that are high in calcium, such as milk, yogurt, cheese, or calcium-fortified food? _______ Per day _______ Per week _______Per month Never Don't know/Not sure

9. During the past month, how often did you eat whole-grain foods such as whole grain bread or rolls, brown rice, or oatmeal? _______ Per day _______ Per week _______Per month Never Don't know/Not sure
10. During the past month, how often did you eat snacks such as sweet or sugary foods (candy, cookies, cake) or salty foods (chips, pretzels)? _______ Per day _______ Per week _______Per month Never Don't know/Not sure

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11. During the past month, how often did you drink regular soft drinks or sodas (not diet)? _______ Per day _______ Per week _______Per month Never Don't know/Not sure
12. During the past 12 months, have you maintained a healthy weight? Yes [Go to Question 15] No
13. During the past 12 months, have you tried to lose weight? Yes No
14. During the past 12 months, did you succeed in losing weight? Yes No
15. Have you smoked at least 100 cigarettes in your entire life? (NOTE: 5 packs = 100 cigarettes) Yes No [Go to Question 19] Don't know/Not sure
16. Do you now smoke cigarettes every day, some days, or not at all? Every day Some days Not at all Don't know/Not sure
17. During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking? Yes No Don't know/Not sure
18. During the past 12 months, have you contacted the Georgia Tobacco Quit-Line to help you quit smoking? Yes No Don't know/Not sure
19. On how many days during the past month did pain make it hard for you to do your usual activities, such as self-care, work, or recreation? None 1-5 days 6-15 days More than 15 Don't know/Not Sure
20. On how many days during the past month have you felt sad, blue, or depressed? None 1-5 days 6-15 days More than 15 Don't know/Not Sure
21. On how many days during the past month have you felt worried, tense, or anxious? None 1-5 days 6-15 days More than 15 Don't know/Not Sure
22. On how many days during the past month did you have a poor appetite or ate too much? None 1-5 days 6-15 days More than 15 Don't know/Not Sure
23. On how many days during the past month have you felt you did not get enough rest or sleep? None 1-5 days 6-15 days More than 15 Don't know/Not Sure
24. On how many days during the past month have you felt very healthy and full of energy? None 1-5 days 6-15 days More than 15 Don't know/Not Sure

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25. How long has it been since you last visited a doctor for a routine checkup or general physical exam?

Within past year

Between 1 and 2 years Between 2 and 5 years

5 or more years ago Don't know/Not sure

Never

26. As an adult, have you ever been told by a doctor, nurse, or other health professional that you have any of the following medical conditions:

High blood pressure
High blood cholesterol
Diabetes
Kidney disease
Any form of arthritis (osteoarthritis, rheumatoid arthritis, fibromyalgia, gout, lupus)

Yes Yes Yes Yes

No No No No

Don't know/Not Sure Don't know/Not Sure Don't know/Not Sure Don't know/Not Sure

Yes No Don't know/Not Sure

Osteoporosis Asthma or other lung problems Any form of cancer

Yes Yes Yes

No No No

Don't know/Not Sure Don't know/Not Sure Don't know/Not Sure

27. What is your age? _________

28. What is your gender? Male Female

29. What is your race/ethnicity? African American Asian Hispanic Native American

30. About how much do you weigh without shoes? ___________

31. About how tall are you without shoes? ___________________

32. Which of the following statements best expresses your CURRENT feelings about your health:
I stay active, eat right, don't smoke, and my doctor says I am in good shape for my age.
I have started doing something to improve my health (physical activity, healthy eating, quit smoking) within the past two months, but haven't reached my goals yet.
I have taken some steps toward being healthy, but have not been very consistent yet with my efforts.
I have been thinking about doing something to improve my health, but haven't reached any decisions or made a definite plan yet.
I think there's plenty of time for me to do something to improve my health -- LATER.

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SAMPLE HEALTH RISK ASSESSMENT

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SCREENING GUIDELINES FOR WOMEN AND MEN

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SCREENING GUIDELINES FOR WOMEN AND MEN

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WELLNESS AND SUSTAINABILITY FOCUS AREAS U.S. General Services Administration
As part of a drive to improve the health of federal employees, the General Services Administration (GSA) is implementing new wellness and sustainability criteria for food service operations. The items below represent industry trends and practices that the federal government would like maximize in its concessions operations.
Wellness Requirements To what degree can you implement the following wellness oriented concepts relative to market pricing and consumer acceptability?
Menu Planning Involving a registered dietitian or nutritionist in the preparation of the menus, recipes and quality control process (recipe adherence, proper handling, etc.). Offering variety in menu choices to accommodate light, vegetarian, and organic eaters. Offering menu selections for patrons with special dietary considerations like low cholesterol, low fat, low sodium and heart healthy.
Food Preparation Maximizing the use of healthier cooking techniques in all food preparation. Featuring hormone-free meat, fish and poultry (specifically, recombinant bovine growth hormone and non-therapeutic antibiotics). Eliminating or greatly reducing trans fatty acids and saturated fats in addition to lowering of fat content without sacrificing taste or quality.
Marketing Utilizing subtle and overt means of presenting and promoting wellness in general as well as providing controlled portions for light eaters and/or those with medically defined restrictions. Providing specific nutritional information (including caloric, sodium, fat content, etc) on food items at the point of choice to educate consumers about healthier food options. Utilizing media/technology to provide easily accessible nutrition information for the customers and the strategic placement of useful nutrition information about the products served at the point of choice. Utilizing the USDA's Dietary Guidelines for Americans in food labeling and food promotions.
Portions and Pricing Featuring a pricing strategy that favors healthier food options.
Use of Technology/Wellness Services Availability of a nutritionist or registered dietitian for patron contact and consulting.

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Sustainability Requirements To what degree can you implement the following environmental and sustainability oriented concepts relative to market pricing and consumer acceptability?
Green Purchasing Utilizing bulk purchasing programs in lieu of individually packaged products to include, but not be limited to, beverages and condiments. Where seafood options are offered, provide those procured from responsibly managed, sustainable, healthy fisheries.
Green Cleaning Utilizing Green Seal certified or nontoxic and biodegradable cleaning products.
Recycling/Waste Management Programming for customers that bring their own re-usable products (e.g. coffee mugs, soda cups, lunch trays, etc.). Utilizing compostable pre-bottled beverages or pre-bottled beverages that minimize plastic content. Featuring disposables and trays (reusable and disposable) that contain recycled content, are processed chlorine free and are petroleum-free (except reusable trays). All disposable products must be "compostable" specify brand or organic composition and compatible with the recycling/compost system provided. Use of Polystyrene Foam is prohibited. Minimize waste stream and maximizing the use of recyclable content products. Partnering and engaging with a food bank donation program. Recycling used waste cooking oil.
Sustainable Foods Purchasing locally grown food and/or organic food products as well as all other food products. Using fair-trade, shade grown and bird friendly coffee purchasing program.
Green Operations Offering education and marketing programs that will be used to increase employee and customer awareness of your company's "Green" programs. Incorporating practices that will be used to reduce energy and water use Using an environmental management systems (EMS) to manage all aspects of food service. Featuring other "Green or Sustainability" programs in your operations.
References: Eat Smart North Carolina: Guidelines for Healthy Foods and Beverages at Meetings, Gatherings & Events, NC Division of Public Health Physical Activity and Nutrition Branch. Retrieved on April 25, 2014 from http://www.eatsmartmovemorenc.com/HealthyMeetingGuide/HealthyMeeting Guide.html
General Services Administration. Wellness and Sustainability Focus Areas. Retrieved on April 25, 2014 from http://www.gsa.gov/graphics/pbs/Practices_for_Concessions_Operations.pdf

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TARGETING EMPLOYERS THROUGHOUT GEORGIA
Cardiovascular Health Initiative & Nutrition, Physical Activity & Obesity Program Since 2003, the Cardiovascular Health Initiative and the Nutrition, Physical Activity and Obesity programs have funded the worksite wellness coordinator position and worksite wellness activities. In July 2013, the Cardiovascular Health Initiative was combined with the Nutrition, Physical Activity, Obesity and Diabetes Programs under CDC RFA (1305) State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Associated Risk Factors, and Promote School Health. With this grant, the worksite wellness coordinator will be responsible for completing grant objectives and activities related to the 1305 grant.
From its inception, the worksite wellness initiative has sought to reduce modifiable risk factors associated with chronic disease for employees across the state of Georgia by implementing evidence-based policy, system, and environmental changes. In 2009/2010 the Cardiovascular Health Initiative implemented both the Model Worksite Project and began the pilot of the Work Healthy Georgia Toolkit. The Model Worksite Project was developed to recognize employers who showed a commitment to worksite wellness and employee health. Many of the "model worksites" aided in the pilot of the Work Healthy Georgia Toolkit. The pilot of the work Healthy Georgia Toolkit was conducted by the University of Georgia's Workplace Health Group (Dr. Mark Wilson and Heater Bowen Padilla) and results from the pilot concluded that the Work Healthy Georgia Toolkit was beneficial to worksites that are starting to implement worksite wellness programming. Worksite wellness work/activities were carried out under the Cardiovascular Health Initiative by funding health district, health promotion coordinators to do the work. From 2010-2013, the Cardiovascular Health Initiative funded Cobb-Douglas, Valdosta, Dublin, East Metro, and Savannah to engage in worksite wellness. Similar to other programs in HPDP, workplans were drafted and the work was agreed upon prior to funding the health district. Much of the work focused on worksite policy and environmental changes.

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The worksite wellness work completed by the worksite wellness coordinator for the Cardiovascular Health Initiative and Nutrition, Physical Activity, and Obesity Programs focused on specific grant objectives. You can find the objectives from the Cardiovascular grant in the FY 13 Policy and Environmental Changes file, located on the jump drive. Similar work was completed for the Nutrition, Physical Activity, and Obesity Program (NUT/PA), although worksite wellness under NUT/PA also included lactation support and breastfeeding. For the past four years, the worksite wellness coordinator worked closely with the Maternal and Child Health state Breastfeeding Coordinator to ensure that worksites who were interested in designating a lactation space, had the proper resources. The worksite wellness coordinator also attended Georgia Breastfeeding Coalition meetings and represented DPH on their worksite wellness sub-group.
Different approaches have been taken to target employers throughout the state of Georgia. In the past, the worksite wellness coordinator has reached out to chambers of commerce and local business coalitions, worked with district health promotion coordinators, health insurers, health insurance brokers and presented at Society of Human Resource Management (SHRM) conferences and events. He or she has also chaired a worksite workgroup, a group of individuals who are interested in worksite wellness at the state level. --
References BRFSS (2011). The Georgia Behavior Risk Factor Surveillance System. Retrieved on April 22, 2014 from: https://dph.georgia.gov/sites/dph.georgia.gov/files/related_files/site_page/2011 %20BRFSS%20Report.pdf
Escofrrey, C., Kegler, M., Alcantara, I., Wilson, M., Glanz, K. (2011). A Qualitative Examination of Small, Rural Worksites in Obesity Prevention. Preventing Chronic Disease. 8(4): A75. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136971/

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ESTABLISHING A WORKSITE FARMERS' MARKET
Getting Started Before setting up a farmers market, you will want to familiarize yourself with how they run. You may want to visit farmers markets in the local area to observe vendors, customers, and take to the Market Manager. Once you decide to implement a farmers' market at your worksite, you'll need to1:
Gain support from management and leadership Find employees to champion the project Survey employees to determine their interest Set goals for your farmers' market Create a farmer's market planning team
Support From Senior Leadership Create a proposal for senior leadership to approve. In the proposal include the number of interested employees, the cost of hosting a famers' market, a list of nearby businesses that may be willing to partner in hosting the market. Leadership will need details so that budget and staffing can be approved. Present the plan and ask for input. Ask if one member of leadership would be willing to champion the project.1
Survey Your Employees Prior to presenting the plan to senior leadership, survey your colleagues to determine interest in having an onsite farmers' market. Include questions related to their previous farmers' market experience, the amount of money they would expect to spend, and how the market would impact the perception of the worksite's wellness culture.
Create a Planning Committee or Team Create a planning team that includes key partners from your organization. The team should include a project champion and representatives from legal/risk management, labor unions, building operations/security, human resources, health plan/wellness team, marketing or communications, and your leadership champion.

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Set Goals for Your Farmers' Market What kind of participation would you like to see? How many vendors would you like to host? Setting goals for your famers' market is the only way to track progress.
You can track progress by creating SMART objectives. SMART stands for
S Specific: Make your goal specific to your outcome. What do you want to achieve? M Measureable: How will you measure your goal? Do you want to form once committee or
have five vendors? Assigning a number will help you measure your success! A Attainable: Can you achieve your goal? R Realistic: Is your goal realistic? Consider your time period and taking small, realistic steps. T Time bound: Select a date. When do you want your goal completed?
A great example for establishing an onsite farmers' market might look like:
By April 30, 2014, identify at least three worksites who would be willing to partner in hosting an onsite farmers' market.
By June 30, 2014, identify at least two vendors for our onsite farmers' market.
Plan Your Farmers' Market Vendors will want to know how many customers to expect. You will be able to provide a rough estimate from the surveys that you had your employees fill out. Knowing how many customers to expect will allow vendors to estimate the amount of product to bring and determine if your event if an appropriate fit for them.
If you expect to have less than 100 customers at your event, an onsite farmers' market may not be appropriate for your site. Vendors may not be able to participate if they cannot make at least $100 in profit. If you anticipate a small turnout, partnering with a local Community Supported Agriculture (CSA) may be your best option. You can also educate your employees on supporting CSA's and local farmers.

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ESTABLISHING A WORKSITE FARMERS' MARKET
Choose Your Date and Time You will want to choose your date and time appropriately. Most employers plan their market around payday and toward the end of the work week. Many employees purchase groceries on the weekend, having a farmers' market onsite would allow them to purchase fresh food for their families. Vendors that you consider for your market, will have season-long commitment to farmers' markets on the weekends.1
Set Your Rules Before starting your market, you will want to establish a list of rules. Here are some items to consider1:
Will you allow only local farmers or will you allow carrying (the sale of wholesale items or items that are produced by someone else).
What are your product limitations? (Meat, poultry, eggs, carrying, etc.) Will you allow vendors to hand out samples? Will vendors need to set up a tent or can they sell out of their vehicles? Do you have an inclement weather policy? How many vendors can your worksite accommodate? Will you assign the vendor stalls or can they pick? How will set-up logistics be handled? What will be provided in the vendor stalls (tables, chairs, trashcan, etc.) Will you charge a fee to the vendors? Will you provide electricity?
Product Limitations Products that are perishable such as eggs, meat, and poultry need to be refrigerated. If you do not plan on allowing vendors to bring their generators or to provide electricity, you will need to prohibit the sale of these items. If you choose to allow meat and poultry, then these products must come from USDA-approved sources and vendors must show proof of the approved source.
Food Safety To ensure food safety, your vendors must comply with the requisite food safety and trading standards required by your local government. Check with your state Department of Public Health for standards and regulations.

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Sampling If you want to allow customers to taste samples while visiting your farmers' market, make sure to include this in your contract so that vendors know how to prepare samples before the market. Allowing samples encourages the promotion of sales for the vendor and creates a satisfied customer. You will want to consider health code restrictions, in most areas samples must be prepared in a licensed kitchen.1
Vendor Management If you need to recover operating costs as an organization, then charging vendors to rent space is an option. This will also discourage vendor cancellation. You may consider piloting your market to see if you have successful participation before charging vendors a fee.
Plan Your Promotional Campaign The best way to ensure a great turnout at your farmers' market is to PROMOTE IT! Establish a marketing plan with your communications team. If you open the market to community members, plan on creating both an internal and external communications plan.
REFERENCES Health Alliance Plan of Michigan. (n.d). Worksite Farmers' Market How-To Guide. Retrieved on June 15, 2014 from: https://www.hap.org/employers/worksite/pdfs/farmers_market.pdf

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WORKSITE WELLNESS FOR SCHOOL EMPLOYEES
Recommended Steps for SHAPE Grantees Basic Award:
Identify members to serve on an employee wellness committee Employee wellness committee: Meets regularly (meeting agendas, minutes, and calendar provided to state SHAPE
coordinator). Conducts an employee needs and interest survey From the survey results, identifies at least two focus areas related to employee wellness
(nutrition, physical activity, lactation support, etc.)
Implementation Award: Creates measurable objectives related to the selected focus areas. Implements activity/program related to two focus areas Evaluates participation/program (sign-in sheets, surveys, etc.)
Conduct an Assessment Georgia Worksite Assessment Tool Link: https://dph.georgia.gov/sites/dph.georgia.gov/files/related_files/site_page/DPH%20 Worksite%20Assessment%20GWAT%20_Toolkit_ver2.pdf
Example Employee Interest Surveys https://www.hap.org/employers/worksite/pdfs/sample_employee_interest_survey.pdf http://www.welcoa.org/freeresources/pdf/ni_survey.pdf
Create Objectives Objectives should be SMART:
S Specific
M- Measureable
A Achievable
R Relevant
T- Time bound
Examples: By September 1, 2014 at least 5 employees will be identified to serve on the worksite wellness committee.
By October 1, 2014 Shady Hills Elementary School will have an official worksite wellness committee.
By May 1, 2014 a physical activity program for school staff will be implemented.

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Physical Activity
Create a Physical Activity Policy That: Encourages physical activity during meetings or breaks Allow employees to take an additional fifteen or thirty minutes during the day to be physically active
Conduct an Environmental Change: Recreational Areas - Create a walking trail or path by measuring the distance around your parking lot or sidewalks - Create a recreational area for employees by dedicating an empty conference for employees to use during their break time Bike Racks
- Install a bike rack close to the building entrance - If you have multiple building entrances, install multiple bike racks so that employees can park
as close as possible to their normal office entrance. - Advertise the locations of your bike racks in your employee newsletter, internal website, or other
communication methods Stairwells - Open stairwells for employee use - Decorate stairwells to encourage use - Put up motivational signs outside stairwells and near elevators encouraging employees to use
the stairs - Install better lighting - Paint the walls in the stairwells with bright and attractive colors - Hang artwork or pictures of employees in the stairwells
Nutrition
Create a Nutrition Policy That:
Follows nutrition guidelines presented in: CDC's Establishing Healthy Eating and Active Living at the Workplace Meetings, Conferences, Parties, and Other Events
Conduct an Environmental Change:
Host an on-site farmer's market once a week
Serve water as an option at staff meetings
nutrition guidelines presented in: CDC's Establishing Healthy Eating and Active Living at the Workplace Meetings, Conferences, Parties, and Other Events
Resources Work Healthy Georgia Toolkit, Alliance for a Healthier Generation Healthy Schools Program Framework, Georgia Tobacco Use Prevention Quitline Materials (private schools), State Health Benefit Plan materials (public/state schools)

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WORKSITE WELLNESS FOR SCHOOL EMPLOYEES PPT SLIDES 1 OF 8

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WORKSITE WELLNESS FOR SCHOOL EMPLOYEES PPT SLIDES 2 OF 8

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WORKSITE WELLNESS FOR SCHOOL EMPLOYEES PPT SLIDES 4 OF 8

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WORKSITE WELLNESS FOR SCHOOL EMPLOYEES PPT SLIDES 5 OF 8

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WORKSITE WELLNESS FOR SCHOOL EMPLOYEES PPT SLIDES 6 OF 8

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WORKSITE WELLNESS FOR SCHOOL EMPLOYEES PPT SLIDES 8 OF 8

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SAMPLE SIGNAGE

Source: Centers for Disease Control and Prevention, Healthier Worksite Initiative. Motivational Signs. Available at: http://www.cdc.gov/nccdphp/dnpao/hwi/toolkits/stairwell/motivational_signs.htm#Message Ideas

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Lactation Policy Supporting Breastfeeding Employees
In recognition of the well documented health advantages of breastfeeding for infants and mothers, [name of company] provides a supportive environment to enable breastfeeding employees to express their milk during work hours. This includes a company-wide lactation support program administered by [name of department].
[Name of company] subscribes to the following worksite support policy. This policy shall be communicated to all current employees and included in new employee orientation training.
Company Responsibilities Breastfeeding employees who choose to continue providing their milk for their infants after returning to work shall receive:
Milk Expression Breaks Breastfeeding employees are allowed to breastfeed or express milk during work hours using their normal breaks and meal times. For time that may be needed beyond the usual break times, employees may use personal leave or may make up the time as negotiated with their supervisors.
A Place to Express Milk A private room (not a toilet stall or restroom) shall be available for employees to breastfeed or express milk. The room will be private and sanitary, located near a sink with running water for washing hands and rinsing out breast pump parts, and have an electrical outlet. If employees prefer, they may also breastfeed or express milk in their own private offices, or in other comfortable locations agreed upon in consultation with the employee's supervisor. Expressed milk can be stored [in general company refrigerators/in designated refrigerators provided in the lactation room or other location/in employee's personal cooler].
Breastfeeding Equipment [Name of company] [provides/subsidizes/rents] electric breast pumps to assist breastfeeding employees with milk expression during work hours. The company provides [hospital grade pump that can be used by more than one employee/or portable personal use electric breast pump that the employee retains] throughout the course of breastfeeding for the employee. [If using a standard hospital-grade pump, indicate whether the company provides/subsidizes personal attachment kit or where the employee can purchase the kit.] [Indicate whether breast pumps are also available for partners of male employees.]

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Lactation Policy Supporting Breastfeeding Employees (continued)
Education Prenatal and postpartum breastfeeding classes and informational materials are available for all mothers and fathers, as well as their partners. Staff Support Supervisors are responsible for alerting pregnant and breastfeeding employees about the company's worksite lactation support program, and for negotiating policies and practices that will help facilitate each employee's infant feeding goals. It is expected that all employees will assist in providing a positive atmosphere of support for breastfeeding employees.
[List other components specific to your company's program]
Employee Responsibilities Communication with Supervisors Employees who wish to express milk during the work period shall keep supervisors informed of their needs so that appropriate accommodations can be made to satisfy the needs of both the employee and the company.
Maintenance of Milk Expression Areas Breastfeeding employees are responsible for keeping milk expression areas clean, using antimicrobial wipes to clean the pump and area around it. Employees are also responsible for keeping the general lactation room clean for the next user. This responsibility extends to both designated milk expression areas, as well as other areas where expressing milk will occur.
Milk Storage Employees should label all milk expressed with their name and date collected so it is not inadvertently confused with another employee's milk. Each employee is responsible for proper storage of her milk using [company provided refrigerator/personal storage coolers].
Use of Break Times to Express Milk When more than one breastfeeding employee needs to use the designated lactation room, employees can use the sign-in log provided in the room to negotiate milk expression times that are most convenient or best meet their needs.
(Source: Adapted from the Business Case from Breastfeeding Easy Steps to Supporting Breastfeeding Employees)
References U.S. Department of Health and Human Services, Health Resources and Services Administration, (HRSA), Maternal and Child Health Bureau. (2008). The Business Case for Breastfeeding, Steps for Creating a Breastfeeding Friendly Worksite -Easy Steps for Supporting Breastfeeding Employees. Retrieved from: http://mchb.hrsa.gov/pregnancyandbeyond/ breastfeeding/easysteps.pdf

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Model Smokefree Policy
ABC COMPANY TOBACCO-FREE POLICY ABC Company is dedicated to providing a healthy, comfortable, and productive
work environment for our employees.
The 2006 U.S. Surgeon General's Report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, has concluded that (1) secondhand smoke exposure causes disease and premature death in children and adults who do not smoke; (2) exposure of adults to secondhand smoke has immediate adverse effects on the cardiovascular system and causes coronary heart disease and lung cancer; (3) there is no risk-free level of exposure to secondhand smoke; and (4) establishing tobacco-free workplaces is the only effective way to ensure that secondhand smoke exposure does not occur in the workplace, because ventilation and other air cleaning technologies cannot completely control for exposure of nonsmokers to secondhand smoke. (U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.) According to the 2010 U.S. Surgeon General's Report, How Tobacco Smoke Causes Disease, even occasional exposure to secondhand smoke is harmful and low levels of exposure to secondhand tobacco smoke lead to a rapid and sharp increase in dysfunction and inflammation of the lining of the blood vessels, which are implicated in heart attacks and stroke. (U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Healzzth and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.)
Numerous studies have found that tobacco smoke is a major contributor to indoor air pollution, and that breathing secondhand smoke (also known as environmental tobacco smoke) is a cause of disease in healthy nonsmokers, including heart disease, stroke, respiratory disease, and lung cancer. The National Cancer Institute determined in 1999 that secondhand smoke is responsible for the early deaths of approximately 53,000 Americans annually.
According to the World Health Organization, scientific evidence has firmly established that there is no safe level of exposure to second-hand tobacco smoke, a pollutant that causes serious illness in adults and children, and that implementing 100% smoke-free environments is the only effective way to protect the population from the harmful effects of exposure to secondhand smoke. The Americans With Disabilities Act, which requires that disabled persons have access to public places and workplaces, deems impaired respiratory function to be a disability.
The U.S. Centers for Disease Control and Prevention has determined that the risk of acute myocardial infarction and coronary heart disease associated with exposure to tobacco smoke is non-linear at low doses, increasing rapidly with relatively small doses such as those received from secondhand smoke or actively smoking one or two cigarettes a day, and has warned that all patients at increased risk of coronary heart disease or with known coronary artery disease should avoid all indoor environments that permit smoking.
Smoke-filled workplaces and workplaces with high numbers of tobacco users result in higher worker absenteeism due to respiratory disease, lower productivity, higher cleaning and maintenance costs, increased health insurance rates, and increased liability claims for diseases related to exposure to secondhand smoke.

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SAMPLE POLICIES Sample Smoking Policy (continued)

Unregulated high-tech smoking devices, commonly referred to as electronic cigarettes, or "e-cigarettes," closely resemble and purposefully mimic the act of smoking by having users inhale vaporized liquid nicotine created by heat through an electronic ignition system. After testing a number of e-cigarettes from two leading manufacturers, the Food and Drug Administration (FDA) determined that various samples tested contained not only nicotine but also detectable levels of known carcinogens and toxic chemicals, including tobacco-specific nitrosamines and diethylene glycol, a toxic chemical used in antifreeze. The FDA's testing also suggested that "quality control processes used to manufacture these products are inconsistent or non-existent." ([n.a.], "Summary of results: laboratory analysis of electronic cigarettes conducted by FDA," Food and Drug Administration (FDA), July 22, 2009; http://www.fda.gov/ NewsEvents/PublicHealthFocus/ucm173146.htm Accessed on: October 22, 2009.) E-cigarettes produce a vapor of undetermined and potentially harmful substances, which may appear similar to the smoke emitted by traditional tobacco products. Their use in workplaces and public places where smoking of traditional tobacco products is prohibited creates concern and confusion and leads to difficulties in enforcing the smoking prohibitions.

In light of these findings, ABC Company shall be entirely tobacco-free effective _________
Date
All tobacco use, including the use of cigarettes, e-cigarettes, candy and flavored cigarettes, chewing tobacco, snuff, snus, blunts, blunt wraps, pre-wrapped blunt cones & tubes, cigars, cigarillos, bidis, pipes, dissolvables and other tobacco products , shall not be permitted in any enclosed company facility and on the grounds of any company facility, including parking lots. Tobacco use is also prohibited in any outdoor company worksite. This includes, without limitation, common work areas, auditoriums, classrooms, conference and meeting rooms, private offices, elevators, hallways, medical facilities, cafeterias, employee lounges, stairs, restrooms, construction sites, temporary offices such as trailers, and owned, leased and operated company vehicles regardless of their location. This policy includes all company sponsored events, regardless of their location, and it applies to all employees, clients, contractors, vendors, volunteers and visitors twenty-four hours a day, seven days a week. Copies of this policy shall be distributed to all employees. No Tobacco signs shall be posted at entrances to all company facilities and at all applicable outdoor worksites and parking lots. This policy is being announced three months in advance in order to give employees time to adapt to its restrictions and to facilitate a smooth transition to a tobacco-free environment. Those employees who use tobacco products and would like to take this opportunity to quit are invited to participate in the cessation programs being offered by the company. No tobacco-related advertising or sponsorship shall be permitted on company grounds, indoor or outdoor, at company sponsored events regardless of their location, or in publications and promotional materials produced by the company. The success of this policy will depend on the thoughtfulness, consideration, and cooperation of both smokers and nonsmokers. All employees share in the responsibility for adhering to and enforcing this policy. All employees are authorized and encouraged to communicate this policy with courtesy and diplomacy to other employees, clients, contractors, vendors, volunteers and visitors. If situations arise where employees are not comfortable fulfilling this function, they should notify their supervisors of violations. Every effort will be made to insure that all employees, clients, contractors, vendors, volunteers and visitors fully understand the policy. (Name of company/worksite) shall provide information on the Georgia Tobacco Quit Line, if they need assistance in quitting tobacco. Non-conformity by employees and contractors to this policy may be subject to disciplinary action under company provisions.

____________________________________________________
Signature of CEO or President

___________________
Date

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Sample Health Foods Policy
__________________________________________is committed to our employees and to providing a work environment that encourages and supports employee and workplace health. Research has demonstrated the association between dietary intake and chronic diseases such as heart disease, diabetes and cancer.
In light of this, ________________________________ believes that food offered on the premises and at off-site company functions, should include healthy food choices that support our employees' efforts to maintaining their health and prevent disease.
Therefore,______________________________________will provide one or more healthful entrees, side dishes or dessert selections at company meetings and functions.
Breakfast offerings will include whole grain breads, fruit, and low fat yogurt and cheeses. Lunch offerings will include salads, lean meats, and vegetables. Snack offerings will include whole grain crackers, pretzels, granola bars, and dried fruit. Beverage offerings will include water, 100% juice, and nonfat or low fat milk.

Authorized Representative ________________________________________ Date ___________________________________________________________

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Health Healthy Eating/Meeting Policy

Implementation Plan

Introduction

The workplace environment can have a significant impact on health-related behaviors. Because the

majority of Georgia spend most of their time at work; the food available at the worksite can

frequently determine what individuals eat throughout the day. Worksite meetings and gatherings

can promote healthier food options by following the recommendations put forth by the Dietary

Guidelines for Americans by offering:

More fruits and vegetables

Use lower fat versions of condiments

Non or low fat milk options Whole grains Foods that are low in saturated and trans fats Smaller serving sizes Lean protein Low calorie or low fat food options Include a vegetarian option Offer seasonal or local foods

For mid-morning or mid-afternoon meetings, consider serving only beverages
Serve only 100% juice
Serve low-fat or skim milk with coffee and tea
Offer water with meals and snacks
On conference/meeting registration forms provide space to indicate food allergies or dietary restrictions

In Eat Smart North Carolina: Guidelines for Healthy Foods and Beverages at Meetings, Gatherings, and Events, the state of North Carolina recommends five guidelines that can be applicable to the work environment. The recommendations include:

Guideline # 1: Offer healthy food choices at company breakfasts, lunches, dinners, potlucks and receptions. Employers can focus on serving fruits and vegetables that are low in calories and high in vitamins, minerals, and fiber. Smaller portion sizes can offered along with low calorie beverages such as water, unsweetened tea, and low-fat milk.

Guideline # 2: Offer alternatives to food at mid-morning or mid-afternoon meeting breaks. As an employer, consider if it is necessary to provide food at meetings, presentations, and events; especially those held during mid-morning and mid-afternoon hours. Food does not have to be everywhere and does not have to be used to motivate employees to attend events. Consider offering only beverages or offering a physical activity break during meetings.

Guideline #3: Identify the healthy food and beverage choices. During work-related events, encourage employees to bring and identify healthy food options. Consider adopting ways that you can encourage ways to identify healthy foods and beverages.

Guideline #4: Keep food safe to eat. Ensure that foods served at the worksite are free from harmful bacteria and viruses by storing the food properly. From farm to table, everyone shares in the responsibility of keeping food safe by washing hands, cleaning surfaces, and separating raw, cooked and ready to eat foods while shopping, preparing, and storing.

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Healthy Eating/Meeting Policy (continued)
Guideline #5: Lead by example: When a company's leaders become role models for choosing healthier food options it makes a powerful statement. Show your employees that you are concerned about their health and well-being by singing a formal Health Meeting/Food Policy.
Action Steps Set up a committee or task force to oversee the policy implementation process. Include District Health Directors, management, and employees. Gather information to educate the taskforce and employees. Survey your employees about their knowledge and concerns about the policy so that concerns can be addressed before the policy goes into effect. Create a communication plan. Make sure that the policy is clear and simple.
Announce the policy several months before the start date with a letter from the Commissioner. Train managers on how to handle employee concerns and questions. Educate DPH employees about the reasons for the policy by using webinars, the DPH weekly newsletter, or a series of informational meetings.
Announcing the Policy The planning committee should decide on a date when the policy will take effect, allowing for sufficient time to carry out the communications plan. Consider scheduling the effective date of the policy to coincide with National Nutrition Month (March).
Promotion of the new healthy eating/meeting policy should begin at least two months before it takes effect. Periodic reminders should be sent to employees during the period leading up to the date the policy takes effect. One final announcement from the Commissioner or District Health Director should occur before the policy takes effect.
Creating a Supportive Environment Work with the Georgia Building Authority (GBA) vendors and the DPH liaison to GBA to establish a consistent message. This would include serving healthier food options in vending machines and on-site shops.
Enforcing & Monitoring the Policy In the weeks prior to the policy taking effect, DPH leadership should communicate to management their role in enforcing the policy, including specific guidance on how to correct non-compliances, procedures, and complaints.
After the policy has been implemented, carefully monitor feedback and any issues related to noncompliance or confusion. Clarify and adjust the policy when needed.

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ADDITIONAL ONLINE RESOURCES
http://livehealthygeorgia.org Resources for schools, worksites, and communities, maintained by the Georgia Department of Public Health.
http://health.nih.gov - National Institute of Health provides many articles on food, nutrition, and metabolism.
http://www.cdc.gov/tobacco/how2quit.htm - The Centers for Disease Control provides tips on how to stop smoking.
http://www.mindfulnessdc.org/mindfulclock.html - Downloadable program that will chime a reminder bell at set intervals, to remind employees to stretch or move throughout the day.
http://www.womenshealth.gov/breastfeeding/government-in-action/business-case-forbreastfeeding/ -The Business Case for Breastfeeding, includes practical, helpful breastfeeding information and resources.
http://www.choosemyplate.gov/ - Many resources on fruits and vegetables, recommendations for men and women, includes food trackers, tools, and recipes.
www.acefitness.org - The American Council on Exercise website provides several areas of information on physical fitness. This council also certifies fitness instructors.
www.acsm.org - American College of Sports Medicine provides several resources for setting up worksite facilities and fitness programs.
http://www.acsworkplacesolutions.com/ - American Cancer Society's online resource for company wellness programs.
www.active.com - Resource listing individual, team, and recreational activities organized all over the United States.
www.ada.gov - The official website of the Americans with Disabilities Act.
www.heart.org - Prevention and early warning signs of heart attack and stroke. Includes a "Healthy Lifestyle" section with several diet and nutrition articles, eating plans, and tools.
www.anti-smoking.org - The Foundation for a Smoke-Free America website has several resources and messages appropriate for both youth and adults.

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ADDITIONAL ONLINE RESOURCES
www.balldynamics.com Source for fitness balls and videos, as well as other comparatively inexpensive fitness equipment.
www.berkeleywellness.com Newsletter on nutrition, fitness, and self-care.
www.bikewalk.org The homepage of of the National Center for Bicycling & Walking (NCBW), whose mission is to help create bicycle-friendly and walkable communities across North America by encouraging and supporting the efforts of individuals, organizations, and agencies.
www.breastcancer.org Information on breast cancer and the Breast Self-Exam.
www.businesscaseroi.org Resources for making the business case for smoking cessation.
www.businessgrouphealth.org Homepage for The National Business Group on Health, which supports its members in the areas of disability, health/productivity, related paid time off and work/life balance issues.
www.cancer.gov The National Cancer Institute, part of the National Institutes for Health, provides extensive information on current statistics, clinical trials, research, and funding.
www.cancer.org The "Resources for Healthy Living" section provides eating, weight, and cooking recommendations, as well as several tools and quizzes to support increased activity. It also provides worksheets and guidelines on early detection and screenings for both women and men and guides for effective smoking cessation.
www.cdc.gov Under "Healthy Living", The Center for Disease Control and Prevention's webpage provides comprehensive guides on nutrition, weight, bone health, food safety, and several other food-related topics.
www.collagevideo.com Website specializing in exercise videos.
www.cspinet.org Advocacy group for food and nutrition issues. Includes the "Nutrition Action" newsletter.
www.diabetes.org Contains sections on preventing diabetes through diet and exercise, as well as managing diabetes once it is diagnosed.
www.eatright.org Although this site is the American Dietetic Association's member website for food and nutrition professionals, it also includes features appropriate for laypersons, like a "Tip of the Day" for good nutrition.

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ADDITIONAL ONLINE RESOURCES
www.fwonline.com "Fitness Wholesale" website source for a full range of fitness equipment.
www.healthletter.tufts.edu Tufts University's health and nutrition newsletter.
www.healthyculture.com Company that assists organizations in efforts to create healthier and more productive cultures.
www.healthyself.org/ The Handbook of Health Assessment Tools is a resource to assist health professionals and others in the selection and implementation of health assessment tools.
www.hopehealth.com Communications resources for workplace wellness programs.
www.humankinetics.com Educational website on physical activity.
www.ihpm.org The Institute for Health & Productivity Management documents and promotes the vital relationship of employee health to workplace productivity.
www.ilca.org Homepage of the International Lactation Consultant Association.
www.komen.org/bse/ Video demonstrations of a Breast Self-Exam, including a self-test of your knowledge of the BSE.
www.lalecheleague.org Homepage for La Leche League International, whose mission is to help mothers worldwide to breastfeed through mother-to-mother support, encouragement, information, and education and to promote a better understanding of breastfeeding as an important element in the healthy development of the baby and mother.
www.mayoclinic.com Medical information and tools for healthy living.
www.physicalfitness.org The National Association for Health and Fitness (NAHF) is a non-profit organization that exists to improve the quality of life for individuals in the United States through the promotion of physical fitness, sports and healthy lifestyles. NAHF accomplishes this work by fostering and supporting Governor's and State Councils and coalitions that promote and encourages regular physical activity.
www.possibility.com/PowerPause/ Website that guides employees through stretching exercises that can help prevent Repetitive Strain Injuries.

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ADDITIONAL ONLINE RESOURCES
www.preventioninstitute.org/CHI_Workplace.html The Prevention Institute offers several tools and statistics that help make the business case for wellness programs in the workplace.
www.webmdhealthservices.com A national provider of health management services for large-scale employers. Develops, implements and manages comprehensive wellness programs.
www.trytostop.org Online community with resources on how to quit smoking.
www.usbreastfeeding.org Homepage for the United States Breastfeeding Committee. The mission of United States Breastfeeding Committee is to improve the Nation's health by working collaboratively protect, promote and support breastfeeding.
www.usda.gov/cnpp An agency of the USDA's Food, Nutrition, and Consumer Services, the Center for Nutrition Policy and Promotion works to improve the health and well-being of Americans by developing and promoting dietary guidance that links scientific research to the nutrition needs of consumers.
www.walkinginfo.org Homepage for the Pedestrian and Bicycle Information Center.
www.welcoa.org Wellness Councils of America, a member organization dedicated to helping organizations of all kinds build and sustain results-oriented wellness programs.
www.wellsource.com Provides lifestyle management tools for organizations looking to reduce health risks and promote overall wellness among employee groups.
www.workforce.com The Workforce Management website provides several articles and resources on the benefits of wellness programs in an overall human resource management strategy.
www.yogaeverywhere.com Provides basic information on yoga practice, and a national directory of yoga classes and instructors.

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REFERENCES
1 National Business Group on Health (2012). Health Benefits and Topics. Retrieved on January 11, 2012 from http://www.businessgrouphealth.org.
2 Centers for Disease Control and Prevention. Chronic Disease Overview: Costs of Chronic Disease. Centers for Disease Control and Prevention Web site. Available at http://www.cdc.gov/nccdphp/overview.htm. Accessed July 24, 2007.
3 National Center for Health Statistics. Health, United States, 2010 with Special Trends on Death and Dying. Hyattsville, MD; 2006.
4 Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (1984-2010).
5 Escofrey C, Kegler M, Alcantara I, Wilson M, Glanz K, 2011. A Qualitative Examination of the Role of Small, Rural Worksites in Obesity Prevention. Preventing Chronic Disease volume 8(4): A75.
6 Hutchinson A, Wilson C, 2011. Improving nutrition and physical activity in the workplace: a meta-analysis of intervention studies. Health Promotion International doi: 10.1093/heapro/dar035. First published online: July 6, 2011.
7 Falb M, Kanny D, Thompson S, Wu M, Powell K. 2006. Georgia Physical Activity Surveillance Report. Georgia Department of Human Resources, Division of Public Health, Chronic Disease, Injury, and Environmental Epidemiology Section. May 2006.
8 Figueroa A, Kanny D, Chowdhury PP, Powell KE. 2004. Georgia Tobacco Surveillance Report. Georgia Department of Human Resources, Division of Public Health, Chronic Disease, Injury, and Environmental Epidemiology Section, September 2004.
9 Kessler RC, Greenberg PE, Mickleson KD, Meneades LM, Wang PS. The effects of chronic medical conditions on work loss and work cutback. Journal of Occupational and Environmental Medicine. 2001;43(3): 218-225.
10 Stewart W, Matousek D, Verdon C. The American Productivity Audit and the Campaign for Work and Health. The Center for Work and Health, Advance PCS. 2003.
11 Chapman LS. Meta-evaluation of worksite health promotion economic return studies: 2005 update. American Journal of Health Promotion. 2005;19:1-16.
12 Center for Prevention and Health Services, National Business Group on Health. Health Improvement: A Comprehensive Guide to Designing, Implementing and Evaluating Worksite Programs. Issue Brief, November 2004, Vol. 1, No. 1.
13 Gordian Health Solutions. When it makes cents to back into the 80/20 rule. Available at: http://www.gordian-health.com/pdf/PDF_8020rule.pdf. Accessed on July 30, 2007.

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16 Centers for Disease Control and Prevention. Making Your Workplace Smokefree: A Decision Maker's Guide. Available at: http://www.cdc.gov/tobacco/secondhand_smoke/workplace_guide.htm.
17 Coffield AB, Maciosek MV, McGinnis M. Priorities among recommended clinical preventive services. American Journal of Preventive Medicine. 2001;21:1-9.
18 U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General-Executive Summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.
19 Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. Journal of the American Medical Association. 2003;289(23):3135-44.
20 National Institute for Occupational Health and Safety. Stress at Work. Cincinnati, OH: 2006.
21 The World Health Organization. The World Health Report 2001: Mental Health: New Understanding, New Hope. Geneva: WHO, 2004.
22 American Psychological Association. (2007, October 4). Stress in America. Retrieved May 18, 2008, from http://apahelpcenter.mediaroom.com/file.php/138/Stress+in+America+REPORT+ FINAL.doc.
23 Rosch, P. J. (Ed.). (2001, March). The quandary of job stress compensation. Health and Stress, 3, 1-4.
24 Valderrama AL, Loustalot F, George MG, Schooley M, Briss P, Dube S, et al. (2011). Million Hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors -- United States, 2011. MMWR; 60(36);124851.
25 Centers for Disease Control and Prevention. (2012). The CDC Worksite Health ScoreCard: An Assessment Tool for Employers to Prevent Heart Disease, Stroke, and Related Health Conditions. Atlanta: US Dept. of Health and Human Services; www.cdc.gov/dhdsp/pubs/docs/HSC_Manual.pdf. Accessed July 26, 2013.
26 Million Hearts. Cardiovascular Health Action Steps for Employers. Retrieved on June 15, 2014 from: http://millionhearts.hhs.gov/Docs/MH_Employer_Action_Guide.pdf

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27 Community Preventive Service Community Preventive Services Task Force. Guide to Community Preventive Services, Cardiovascular Disease Prevention and Control: Reducing Out-of-Pocket Costs for Cardiovascular Disease Preventive Services for Patients with High Blood Pressure and High Cholesterol Web site: www.thecommunityguide.org/cvd/ROPC.html. Accessed July 26, 2013.
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29 Kaye, B. & Jordan-Evans, S. (2008). Love 'em or Lose 'em: Getting good people to stay (4th ed.). San Francisco, CA: Berrett-Koehler Publishers, Inc.
30 Pronk N, Googman M, O'Connor P, Martinson B. Relationship between modifiable risks and shortterm health care charges. Journal of the American Medical Association. 282:23; 2235-2239.
31 American Heart Association. Saving Lives with Automated External Defibrillation. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3010773. Accessed on August 6, 2007.

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