Worksite Health 101 Training Survey: Part I-III

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

CDC National Healthy Worksite Program
Worksite Health 101 Training Survey: Parts I-III
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
Representative from
Community Participants
(participating in Worksite
Health 101 Parts I-III training
sessions)

Content
Usefulness of Worksite
Health 101 Parts I-III
training sessions
Resources and barriers
for success

Timing
Administered 2
months after the
completion of
Parts I-III of Worksite
Health 101 trainings
(November 2012)

Respondents
300

Time per
respondent
@ 0.25 hrs

Implementation: This is a planned web survey of the employer representatives who participated in one or
more of the Worksite Health 101 Parts I –III training sessions. This survey will be administered in
November, 2012, 2 months after the completion of Worksite Health 101 training Part III.
Introduction
Thank you for taking time today to help us better understand issues related to the National Healthy
Worksite (NHW) program. You recently participated in one or more of the Worksite Health 101
trainings offered through the National Healthy Worksite Program. This survey asks about your
thoughts and opinions of these trainings. This survey should take about 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
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technical services to clients worldwide. They are helping CDC evaluate the National Healthy
Worksite (NHW) program.
You were asked to participate because of your participation in NHWP Healthy Worksite training.
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 survey 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
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.

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1. The table below asks you to indicate how informative and how useful you found each of the
Worksite Health 101 sessions to be and to select the most useful parts of each session. It also
asks you to rate the instructor’s knowledge and delivery of the session topics.
Session

Did not

How

How useful

If you found the

Please rate the

Please rate the

attend

informative

was the

session to be

instructor’s

instructor’s

was the

session?

useful, what were

knowledge of

delivery of the

session?

(Select one)

the most useful

the topics

session materials.

parts of the

covered.

(Select one)

session? (Select all

(Select one)

(Select one)

that apply)
Worksite Health101

[1] Not at all

[1] Not at all

[1] Cost of unhealthy

[1] Not at all

[1] Extremely poor

Part I: Making the

informative

useful

workforce

knowledgeable

[2] Below average

Case and Leadership

[2] Not very

[2] Not very

[2] Fiscal value of worksite

[2] Not very

[3] Average

[May, 2012]

informative

useful

health programs

knowledgeable

[4] Above Average

[3] Somewhat

[3] Somewhat

[3] How to identify and

[3] Somewhat

[5] Excellent

informative

useful

impact manager's attitudes

knowledgeable

[4] Very informative

[4] Very useful

towards worksite health

[4] Very

[4] Characteristics of a

Knowledgeable

good worksite health team.

Worksite Health101

[1] Not at all

1] Not at all

[1] Reasons to collect data

[1] Not at all

[1] Extremely poor

Part II: Assessment

informative

useful

[2] Types of data

knowledgeable

[2] Below average

and Data Collection

[2] Not very

[2] Not very

[3] How to identify "the

[2] Not very

[3] Average

[July/Aug, 2012]

informative

useful

good worksite health

knowledgeable

[4] Above Average

[3] Somewhat

[3] Somewhat

marriage"

[3] Somewhat

[5] Excellent

informative

useful

[4] What to do with the

knowledgeable

[4] Very informative

[4] Very useful

data

[4] Very

[5] Introduction to National

Knowledgeable

Healthy Worksite Program
health assessment tools
[6] Health score card

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Session

Did not

How

How useful

If you found the

Please rate the

Please rate the

attend

informative

was the

session to be

instructor’s

instructor’s

was the

session?

useful, what were

knowledge of

delivery of the

session?

(Select one)

the most useful

the topics

session materials.

parts of the

covered.

(Select one)

session? (Select all

(Select one)

(Select one)

that apply)
Worksite Health 101

[1] Not at all

[1] Not at all

[1] Identifying priority

[1] Not at all

[1] Extremely poor

Part III: Data Review,

informative

useful

worksite health issues

knowledgeable

[2] Below average

Worksite Health Plan,

[2] Not very

[2] Not very

[2] Writing measurable

[2] Not very

[3] Average

Implementation,

informative

useful

objectives

knowledgeable

[4] Above Average

Evaluation

[3] Somewhat

[3] Somewhat

[3] Identifying appropriate

[3] Somewhat

[5] Excellent

[Aug/Sep. 2012]

informative

useful

interventions

knowledgeable

[4] Very informative

[4] Very useful

[4] Policies and

[4] Very

environments to support

Knowledgeable

objective
[5] Ways to
evaluate/measure success

2. Prior to attending Worksite Health 101 Parts I-III in communities, how would you rate your level of
knowledge of the session topics?
[1] Beginner
[2] Intermediate
[3] Expert
3. After attending Worksite Health 101 Parts I-III in communities, how would you rate your level of
knowledge of the session topics?
[1] Beginner
[2] Intermediate
[3] Expert
4. Was your worksite selected to participate in the National Healthy Worksite Program and is
currently receiving on-site support and expertise to establish a worksite health program?
[1] Yes
[2] No
5. Prior to the Worksite Health 101 trainings, has your organization done any of the following? (Select
all that apply.)
[1] Engaged leadership for support of worksite health programs
[2] Maintained a worksite health committee or team
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[3] Collected data to use in worksite health program development
[4] Developed an annual worksite health plan
[5] Offered worksite health programs to employees
[6] Evaluated employee satisfaction and overall impact of the worksite health program
[7] None of the above

6.

What did you do with the information you learned in the Worksite Health 101 trainings? (Select
all that apply.)
[1] Shared it with others in my organization, including engaging leadership for support
[2] Established a worksite health committee or team
[3] Identified and collected data for worksite health program development
[4] Developed a worksite health plan but have not taken action
[5] Developed a worksite health plan and have begun to take action
[6] Evaluated employee satisfaction and overall impact of the worksite health program
[7] Used it to develop a new health program or activity at my worksite
Specify activity or activities: ______________________
[8] Used it to improve an existing health program at my worksite
Specify activity or activities: ______________________
[9] Used it to purchase an off-the-shelf health program for my worksite
Specify activity or activities: ______________________
[10] Used it to select a vendor to implement a health program at my worksite
[11] Nothing, because we do not have the resources to implement a worksite health program
[12] Nothing, because I did not think we would have leadership support at my worksite
[13] Nothing, because I did not find the training information to be useful
[14] Other (specify) :__________________________________________________________)

7. What additional tools, training, or technical assistance does your worksite need for the successful
implementation of a worksite health program?
____________________________________________________________________________

8. Did the Worksite Health 101 training sessions help you overcome any barriers to the successful
implementation of a health program at your worksite?
[1] Yes
[2] No [Go to Question 10]
9. Which barriers did the Worksite Health 101 trainings help you overcome? (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
[6] Other (specify: ___________________________________________________________)
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10. What size is your company?
[1] 1 – 100 employees
[2] 101 – 250 employees
[3] 251 – 500 employees
[4] more than 500 employees

11. 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
12. Where is your worksite located?
[Insert list of NHWP locations]
Thank you for your participation in the survey!

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