Employer Follow-Up Survey

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

CDC National Healthy Worksite Program
Employer Follow - Up Survey
Public reporting of this collection of information is estimated to average 15 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).
Respondents/Sources

Method

Content

Timing/Frequency

Respondents

Time

Employer Representative
(HR or chair of wellness
committee, program
champion) -- all worksites

NHW Follow-up
Employer Survey

Program
continuation;
Employee
participation;
Challenges &
strategies for success

Approx. 6 months
into year 3

100

@ 0.25
hrs

Implementation: This planned as a web survey of the wellness coordinator or HR director in all
participating NHW worksites, approximately 6 months following the conclusion of program delivery. We
will do mail/telephone follow-up to non-respondents.
Introduction
Thank you for taking time today to help us better understand issues related to the National Healthy
Worksite (NHW) program. This survey asks about your experience since the end of your formal
participation in the National Healthy Worksite (NHW) program at your worksite. This survey should
take about 10-15 minutes to complete.
Informed Consent
Before you get started, we’d like need to give you some more information to help you decide whether or
not you would like to participate.
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This project is funded by the Centers for Disease Control and Prevention. Many parts of the
project are being managed by Research Triangle Institute International (RTI). RTI is an
independent, non-profit institute headquartered in Research Triangle Park, NC. RTI provides
technical services to clients worldwide. They are helping CDC evaluate the National Healthy
Worksite (NHW) program.
You were asked to participate because of your role in your company’s health promotion activities.
Your participation in this survey is voluntary. In the course of this survey, you may refuse to
answer specific questions. You may also choose to end the discussion at any time.
The discussion is designed to take about 15 minutes.
There are no right or wrong answers or ideas—we want to hear about YOUR experiences and
opinions.
All of the comments you provide will be maintained in a secure manner. We will not disclose your
responses or anything about you unless we are compelled by law. Your responses will be
combined with other information we receive and reported in the aggregate as feedback from the

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group. In our project reports, your name will not be linked to the comments you provide in this
discussion.
CDC is authorized to collect information for this project under the Public Health Services Act.
There are no personal risks or personal benefits to you for participating in this discussion.
We are interested in your comments so that we can improve the NHW program for future
participants. Please feel free to contact Dr. Laurie Cluff at RTI. Her toll-free number is 1-800-3348571 x 6514. You can also call RTI’s Office of Research Protection and Ethics toll-free at 1-866214-2043.

This survey asks about your worksite health program and the specific offerings made to your employees.
For the purposes of this survey these offerings will be referred to as programs.
1. What size is your company?
[1] 1 – 100 employees
[2] 101 – 250 employees
[3] 251 – 500 employees
[4] more than 500 employees
2. What industry best describes your worksite?
[1] Agriculture, Forestry and Fishing
[2] Mining
[3] Construction
[4] Manufacturing
[5] Transportation, Communications and Public Utilities
[6] Wholesale Trade
[7] Retail Trade
[8] Finance, Insurance, and Real Estate
[9] Services
[10] Public Administration
3. What NHW region (1 – 7) was your worksite part of?
[Insert list of states/regional locations]
4. Does your worksite still offer a workplace health program?
[1] Yes – GO to Q5
[2] No
If Q4 = No:
4a. Why did your worksite discontinue the program? (Select all that apply.)
[1] Lack of funding
[2] Lack of staffing support needed to manage the program
[3] Lack of management support
[4] Lack of employee participation
[5] No program champion

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[6] Not satisfied with NHW
[7] Other (Specify:_____________________________)
4b. Has your worksite maintained participation in the community coalition?
[1] Yes – GO to Q4d
[2] No
If Q4b = No:
4c. Why did your worksite stop participating? (Select all that apply.)
[1] Participation diverted time or resources from other priorities
[2] Inadequate influence on coalition activities
[3] Insufficient access to outside organizations/programs/services
[4] Lack of interest from outside organizations
[5] Benefits to my worksite were not apparent
[6] Other (Specify:_____________________________)
4d.

What lessons would you share with other worksites like yours implementing a worksite health
program? [Open-ended]

4e. Why did your worksite choose to maintain membership / participation in the community coalition?
(Select all that apply.)
[1] Opportunities for peer-to-peer networking
[2] Increases the visibility of my organization in the community
[3] Provides access to outside organizations/programs/services
[4] Benefits my worksite through training and assistance
[5] Access to useful data and information
[6] Other (Specify:_____________________________)

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[If Q4 = Yes]:
5. How has the workplace health program (employee worksite health offerings) changed over the past 6
months?
[1] More services/programs offered to employees
[2] Fewer services/programs offered to employees
[3] Programming offered to more employees
[4] Programming offered to fewer employees
[5] Focus of the programming has changed (e.g., from heart health to diabetes)
[6] Other (Specify: ________________)
6. Please indicate the program elements currently offered by your worksite and, if offered, who provides
each service.
Program
element
not
offered

Program
element
provided
by a
vendor

Program
element
provided by
employees

Program
element
provided by
a hospital
or clinic

Program
element
provided by
a community
organization

a. Health
screenings

1

2

3

4

5

b. Health
coaching

1

2

3

4

5

c. Wellness
policies

1

2

3

4

5

d. Healthy food
options available

1

2

3

4

5

e. On-site fitness
facilities

1

2

3

4

5

f. Health
education
seminars (e.g.,
lunch-and-learns)

1

2

3

4

5

g. Walking
groups, fitness
challenges,
and/or other
social wellness
activities

1

2

3

4

5

h. Tobacco
cessation
programs

1

2

3

4

5

4

Program
element
provided by
some other
group or
organization
(Please specify
below)

i. Low-cost or
subsidized gym
memberships
(onsite or off-site)

1

2

3

4

5

j. Employee
health plan
changes (e.g.,
coverage for
over-the-counter
tobacco cessation
products,,
payment structure
changes)

1

2

3

4

5

k. Incentives for
program
participation

1

2

3

4

5

1

2

3

4

5

l. Other
(Please specify
below)

7. Can spouses/other family members participate in components of the programs?
[1] Yes
[2] No

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8. Please rate the following on their level of importance for maintaining the program?
Not
Important

Somewhat
Important

Important

Very
Important

Extremely
Important

Financial Resources

1

2

3

4

5

Staffing for program

1

2

3

4

5

Leadership Support

1

2

3

4

5

Wellness committee/Champions

1

2

3

4

5

Organization Culture Change

1

2

3

4

5

Employee Incentives

1

2

3

4

5

Other

1

2

3

4

5

(please specify):
__________________________

9. Over the next 12 months, what do you foresee for your worksite’s financial investment in employee
health promotion?
[1] My worksite will spend about the same as it currently does
[2] My worksite will spend more
[3] My worksite will spend less
The next few questions ask about the resources needed to support your worksite health promotion
program.
10. What incentives are offered to encourage employee participation in health promotion activities?
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]

None
Reduced insurance premiums/deductibles
Paid time off
Cash incentives (specify amount)
Competitions with prizes
Subsidized gym memberships
Token rewards
Other (please specify_________________________)

11. Does your worksite have an employee(s) or resource(s) inside your organization who help staff the
program (for example, serves as a health coordinator or member of a health coordination team)?
[1] Yes
[2] No– GO to Q13

12. Do they receive any compensation for their time?
[1] They are paid their regular wages
[2] They volunteer their time

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13. Do you pay fan outside vendor, health plan, or individual to provide a full-time or part-time health
services resource to help with the worksite health program?
[1] Yes
[2] No
14. Are there any other major costs associated with the programs? [Open-ended]

15. Are there any areas of cost / spending that have not had a strong impact on program performance or
results? [Open-ended]

16. Are there any other financial benefits you have seen from the program? [Open-ended]

THANK YOU!

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