Tobacco Policy Change - Survey Topics

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This plan describes a company-level survey consisting of three modules. Each module has four parts:1. Profile-company-contact/champion-workforce-worksite(s)2. Objectives-Purpose-Scope-Policy-Timeframe3. Current Situation-policy-cessation benefits & programs-tracking-promotionE

Specify Objectives

Purpose

Directive, legal mandate

Directive, org. leadership

Prospective, under formal consideration

Prospective, will request formal consideration

Preliminary, no formal consideration planned

Scope

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specify by address/zipcode

# sites

Geography

Global

U.S.

multiple states

single state

Policy

must include

must not include

Timeframe

12-18 months

6-11 months

1-5 months

Survey Current Situation

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Use existing Consulting survey questions

Policy

Ban

Smoke-free

Tobacco-free

Restriction

Designated areas

Indoor

Outdoors

Smoke breaks

Vehicles

Events

exisiting site with model policy?

Cessation

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Programs

telephone/online

on-site

Benefits

coverage

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for each, assess level of coverage across all plans

Chantix

Zyban

NRT

NRT-OTC

Counseling

utilization

enrollment

Tracking

Prevalence

Promotion

communication channels

wellness staff

Create Profile

Company

Name

Industry

Decision-makers

User (company rep)

representing

company

single worksite

multiple worksites

authority

decision-maker

delegate

role

primary job responsibility

'other duties as assisgned' responsibility

volunteer

Workforce

# ee's

ee characteristics

demographics

age

gender

race

education

job characteristics

blue-collar

unionized

wages

turn-over

Worksite(s)

Type

HQ/large corporate

other large campus or plant

100+ ee's

<100 ee's

Ownership

owned

shared

Resources

wellness

occ. health

security