Worksite Health 101 Training Survey: Part IV

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

CDC National Healthy Worksite Program
Worksite Health 101 Training Survey: Part IV
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

Content

Representative from
Community Participants
(participating in Worksite
Health 101 Part IV training
session)

Usefulness of Worksite
Health 101 Part IV training
session
Resources and barriers for
success

Timing
Administered 2
months after the
completion of
Part IV of Worksite
Health 101 trainings
(September 2013)

Respondents

Time per
respondent

300

@ 0.25 hrs

Implementation: This is a planned web survey of the employer representatives who participated in the
Worksite Health 101 Part IV training session. This survey will be administered in September, 2013, 2
months after the completion of Worksite Health 101 training Part IV.
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 the Worksite Health 101 training, Part IV,
offered through the National Healthy Worksite Program. This survey asks about your thoughts and
opinions of the training. The 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
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.
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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.
1. The table below asks you to indicate how informative and how useful you found the Worksite
Health 101 Part IV session to be and to select the most useful parts of the 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

Please rate the

Please rate the

attend

informative

was the

the session to

instructor’s

instructor’s

was the

session?

be useful, what

knowledge of

delivery of the

session?

(Select one)

were the most

the topics

session materials.

useful parts of

covered.

(Select one)

the session?

(Select one)

(Select one)

(Select all that
apply)
Worksite Health 101 Part

[1] Not at all

1] Not at all

[1] Areas of success

[1] Not at all

[1] Extremely poor

IV in Communities: Final

informative

useful

identified in worksite

knowledgeable

[2] Below average

Data and Annual

[2] Not very

[2] Not very

health programs

[2] Not very

[3] Average

Planning [July, 2013]

informative

useful

[2] Health behavior

knowledgeable

[4] Above Average

[3] Somewhat

[3] Somewhat

changes measured

[3] Somewhat

[5] Excellent

informative

useful

[3] Policies and

knowledgeable

[4] Very informative

[4] Very useful

environment

[4] Very

changes made

Knowledgeable

[4] Lessons learned
and adjustments
made
[5] Next steps-where do we go
from here?

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2. Prior to attending Worksite Health 101 Part IV 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 101Part IV 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. Did you or someone else in your organization participate in one or more Worksite Health 101 training
sessions held last year (May – September 2012)?
Sessions held last year included: 1) Part I: Making the Case and Leadership, 2) Part II: Assessment
and Data Collection, 3) Part II: Data Review, Worksite Health Plan, Implementation, and Evaluation
[1] Yes
[2] No
[3] Don’t Know
6. Prior to the Worksite Health 101 Part IV training, 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
[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
7. What did you do with the information you learned in the Worksite Health 101 Part IV training?
(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
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[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) :__________________________________________________________)

8. In your opinion, what additional tools, training, or technical assistance does your worksite need for the
successful implementation of a worksite health program?
____________________________________________________________________________

9. Did the Worksite Health 101 Part IV training session help you overcome any barriers to the successful
implementation of a health program at your worksite?
[1] Yes
[2] No [Go to Question 11]

10. Which barriers did the Worksite Health 101 Part IV training 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: ___________________________________________________________)

11. What size is your company?
[1] 1 – 100 employees
[2] 101 – 250 employees
[3] 251 – 500 employees
[4] More than 500 employees

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

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