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	Timing	Respondents	Time per respondent
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	Administered 2 months after the completion of Part IV of Worksite Health 101 trainings (September 2013)	345	@ 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.

• 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.

• 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 1-800-334-8571 x 6514. You can also call RTI’s Office of Research Protection and Ethics toll-free at 1-866-214-2043.

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 attend	How informative was the session? (Select one)	How useful was the session? (Select one)	If you found the session to be useful, what were the most useful parts of the session? (Select all that apply)	Please rate the instructor’s knowledge of the topics covered. (Select one)	Please rate the instructor’s delivery of the session materials. (Select one)
Worksite Health 101 Part IV in Communities: Final Data and Annual Planning [July, 2013]		[1] Not at all informative [2] Not very informative [3] Somewhat informative [4] Very informative	1] Not at all useful [2] Not very useful [3] Somewhat useful [4] Very useful	[1] Areas of success identified in worksite health programs [2] Health behavior changes measured [3] Policies and environment changes made [4] Lessons learned and adjustments made [5] Next steps-- where do we go from here?	[1] Not at all knowledgeable [2] Not very knowledgeable [3] Somewhat knowledgeable [4] Very Knowledgeable	[1] Extremely poor [2] Below average [3] Average [4] Above Average [5] Excellent

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

[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] Used it to support partners or employers that I work with on worksite health programs

Specify activity or activities:______________________

[12] Nothing, because we do not have the resources to implement a worksite health program

[13] Nothing, because I did not think we would have leadership support at my worksite

[14] Nothing, because I did not find the training information to be useful

[15] 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

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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