Employer Phone Interview Guide

Form Approved
OMB No. 0920-XXXX
Exp. Date: XX-XX-XXXX

National Healthy Worksite Program (NHWP)
Employer Phone Interview Guide
Public reporting of this collection of information is estimated to average 20 minutes per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is
not required to respond to a collection of information unless it displays a currently valid OMB control number.
Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74,
Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).
The Employer Interview Guide will be used to conduct phone interviews with those employers that apply to be a
National Healthy Worksite (NHW). The responses to the Employer Interview Form will help to identify, rank, and
select 70 – 100 employers to be Program Participants as part of the NHW program.
Employer Profile
Name of employer:
Contact name:

Title:

Email address:

Phone:

Physical address:
Type of industry:
Number of full-time employees:
Note: If the employer has between 500 and 1,000 full-time employees they must answer “yes” to question 2
to be eligible. If employer has more than 1000 employees and answers “no” question 1 the employer is not
eligible to be a NHW Program Participant.

Questionnaire
Question

Response
yes

no

1a.

Are you nominating a specific individual worksite location not exceeding 1000
full-time employees to participate in the NHW program?
If the employer answers “no” to question 1a and has more than 1000 full-time employees, the
employer is not eligible to be a NHW Program Participant. Review training and networking
opportunities with employers to become a Community Participant.

1b.

Is your worksite an independent business unit or an autonomous unit of a larger
organization?
If the employer answers “no” to question 1b and has more than 1000 full-time employees, the
employer is not eligible to be a NHW Program Participant. Review training and networking
opportunities with employers to become a Community Participant.
1

Question

Response
yes

1c.

Do you have decision making authority to set local policies and procedures
without corporate oversight/approval such as the ability to institute a tobaccofree campus policy when none exists at the corporate level or negotiate local
food vending contracts?
If the employer answers “no” to question 1c and has more than 1000 full-time employees, the
employer is not eligible to be a NHW Program Participant. Review training and networking
opportunities with employers to become a Community Participant.

2

Are you willing to invest $50,000 towards the employee wellness program?
(applicable to employers with 500-1000 full-time employees only)

no

If employer has 500-1000 full-time employees and answers “no” question 2 the employer is not
eligible to be a NHW Program Participant. Review training and networking opportunities for
Community Participants. Interview is ended (see Question 2 response in script)
3

Do you offer health insurance to all eligible employees?
3.1 Are at least 50% of your eligible employees insured?
3.2 Does your health insurance plan cover medical care, mental health, and
preventive care?
If employer answers “no” to any part of question 3 the employer is not eligible to be a NHW
Program Participant. Review training and networking opportunities to become a Community
Participant. Interview is ended (see Question 3 response in script)

If employer has answered “yes” to questions 1, 2 and 3 (if applicable) continue with questions 4 thru 14
4
Leadership
4.1 Are you committed to serve as a role model/champion for healthy lifestyle
behaviors as evidenced by your program participation and engagement?
4.2 Are you committed to allow your employees to participate in employersponsored workplace health programming during work hours?
4.3 Are you committed to adopting and implementing health protection and
promotion programs, policies, and environmental supports to foster a healthy,
safe work environment?
4.4 Are you willing to fully participate in data collection activities?
4.5 Are you willing to share health-related data with Viridian Health
Management?
4.6 Are you committed to fully participate in technical assistance / training
sessions (approximately 20 hours per year)?
4.7 Are you committed to actively participate in a network of National Healthy
Worksites (approximately 1 hour per month?)
4.8 Are you committed to become an active participant in community coalitions
and partnerships?
4.9 Are you willing to be a mentor to other employers?

2

Question
5

Response
yes
no
Programs (eligibility based on having 50% or fewer of the following)
5.1 In the past 12 months has your worksite offered classes or seminars on
fitness, nutrition, and tobacco cessation or stress management? (2 pts.)
5.2 In the past 12 months has your worksite offered, weight management
programs that offer counseling or coaching? (3 pts.)
5.3 In the past 12 months has your worksite offered, physical activity classes or
walking clubs? (3 pts. .)
5.4 In the past 12 months has your worksite offered, tobacco cessation
counseling through a quit line, or health plan? (2 pts.)
5.5 In the past 12 months has your worksite offered, lifestyle coaching or
counseling? (3 pts.)
5.6 In the past 12 months has your worksite offered, signage related to program
components? (1 pt.)

6

Policies (eligibility based on having 50% or fewer of the following)
6.1 In the past 12 months has your worksite offered, a tobacco-free campus
policy? (3 pts.)
6.2 In the past 12 months has your worksite offered, a policy that healthy foods
will be made available at all company meetings or functions where food is
served? (1pt)
6.3 In the past 12 months has your worksite offered, a food procurement policy
that limits the purchase of food and beverages high in sodium, calories, transfats,
or saturated fats? (1 pt.)
6.4 In the past 12 months has your worksite offered, a policy allowing employees
work time or flextime (i.e., flexible scheduling) to engage in employer-sponsored
workplace health program activities such as physical activity programs? (2 pts.)

7

Environmental Support (eligibility based on having 50% or fewer of the following)
7.1 In the past 12 months has your worksite offered, employees access to onsite
or near-by fitness facilities? (3 pts.)
7.2 In the past 12 months has your worksite offered, worksite stairwell
enhancement and improvement? (3 pts.)

7.3 In the past 12 months has your worksite made healthy foods available and
accessible through vending machines or cafeterias? (3 pts.)
7.4 In the past 12 months has your worksite offered, menu labeling/signage
including nutritional information on calories, sodium, trans fats, and saturated
fats? (2 pts.)
7.5 In the past 12 months has your worksite provided employees with food
preparation and storage facilities such as microwave ovens, sinks, refrigerators,
and/or kitchens? (1 pt.)
7.6 In the past 12 months has your worksite had an onsite Farmer’s Market?
(1 pt.)
3

Question

Response
yes
7.7 In the past 12 months has your worksite offered environmental supports for
recreation and exercise such as establishing walking/running trails; utilize multipurpose space for physical activity classes, maps of suitable walking routes,
bicycle racks, open space designated for recreation or exercise, a shower and
changing facility? (in addition to yes/no response, circle each one the employer
has in place). (3 pts.)
7.8 In the past 12 months has your worksite offered a means to identify
recognized health and safety threats and address problems as they arise? (3 pts.)

8

9

10

Worksite Infrastructure (eligibility based on having 50% or fewer of the following)
8.1 In the past 12 months has your worksite had a workplace health council or
committee? (2 pts.)
8.2 In the past 12 months has your worksite had site-level champions? (2 pts.)
8.3 In the past 12 months has your worksite had existing a workplace health
improvement plan? (2 pts.)
8.4 In the past 12 months has your worksite promoted and marketed health
promotion programs to employees (e.g., give the program a brand name or logo,
use multiple channels of communication, send frequent messages) (1 pt.).
8.5 In the past 12 months has your worksite participated in a community health
coalition? (2 pts.)
Assessment and Evaluation (eligibility based on having 50% or fewer of the following)
9.1 In the past 12 months has your worksite conducted employee health risk
appraisals / assessments through vendors, onsite staff, or health plans and
provided individual feedback to employees (e.g. written report, letter, one-onone counseling)? (3 pts.)
9.2 In the past 12 months has your worksite conducted an employee needs and
interests assessment (e.g. focus groups, employee survey) for health promotion
and provide feedback to employees? (1 pt.)
9.3 In the past 12 months has your worksite conducted ongoing evaluations of
health promotion programming that use multiple sources (e.g. employee health
risks, medical claims, employee satisfaction or organizational climate surveys, or
other relevant data)? (1 pt.)
Stability
10.1 Do you anticipate any significant lay-offs or plant closures for the duration
of the project? (approximately 2 years)
10.2 Do you currently have any plans for acquisition, senior leadership turnover,
or company sale for the duration of the project? (approximately 2 years)
10.3 Are there times when a significant number of your employees will not be
available onsite (such as summer vacations, furloughs, plant shut downs, etc.)? If
yes, please list dates :

4

no

Open ended questions (summarize in a maximum of 50 words)
11
What have been the particular hurdles that have kept you from implementing a comprehensive
program in the past?

12

Why do you think your company is a good candidate to be selected to participate in the National
Healthy Worksite Program?

13

What are your main reasons for wanting to participate in the National Healthy Worksite
Program?

14

What are your top three concerns about implementing a comprehensive worksite wellness
program at your worksite?

15

How do you see this program supporting your long term business objectives?

End of Employer Interview
INTERVIEWER USE ONLY
Name:

Title:

Contact information
Email:

Phone:

Notes / Comments:

5