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Does your workplace environment support good health practices?

Physical Activity Environment

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1

Does your worksite have stairs?

Yes No

1.1

Does your workplace do anything to encourage stair use?

Yes No

2

Is it convenient for your employees to walk or ride a bicycle to work?

Yes No

3

Is it safe for your employees to walk or ride a bicycle to work?

Yes No

4

Do you have lockers and/or showers at your workplace?

Yes No

5

Do you have fitness equipment or classes at your workplace?

Yes No

5.1

Do you think your employees are adequately using the equipment or attending classes?

Yes No

6

Do you provide fitness center discounts for employees who exercise away from work?

Yes No

7

Do you support employee physical activity by allowing workers to take walking breaks, to do pre-heavy-labor stretching, or take additional time off during lunch to exercise?

Yes No

8

Do your employees get adequate exercise at work as part of their job?

Yes No

9

Does your company sponsor sports teams such as softball for employees?

Yes No

10

Are there any paths or trails near your worksite on which employees could walk during breaks, lunch or after work?

Yes No

11

Has your worksite ever sponsored a local fun run or fun walk?

Yes No

12

Does your worksite provide any health information (web, brochures, posters, etc) about physical activity or exercise messages to employees?

Yes No

Nutrition Environment

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13

Are healthy food alternatives such as fruits, vegetables, whole grains breads, healthy beverages available on a daily basis?

Yes No

14

Do your food providers use healthy food preparation practices in the cafeteria (steaming, low-fat/salt substitutes, limited frying)?

Yes No

15

Do you have vending machines on site?

Yes No

15.1

Are fruits (dried or fresh), vegetables, low-fat snacks, or other healthy food alternatives available in the vending machines?

Yes No

16

Do employees have access to a microwave at work?

Yes No

17

Do employees have access to a refrigerator at work?

Yes No

18

Does your worksite provide healthy eating messages to employees, such as posters or brochures?

Yes No

19

Does your worksite provide any health information (web, brochures, posters, etc) about nutrition to employees?

Yes No

Smoking Environment

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20

Do you prohibit the hiring of smokers?

Yes No

21

Do you have restrictions such as no smoking in company buildings, in company vehicles, or on company property?

Yes No

Company Wellness Policy

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22

Do you have a wellness committee?

Yes No

23

Do you allow health promotion programs to be provided during company time (not lunch hour)?

Yes No

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