Att C_Survey Instrument Cross Walk

Attachment C - Work@Health^® Survey Instrument Cross Walk

Instrument	Method	Respondents	Time of Data Collection	Program Objective	Data Collected
Accreditation Readiness Assessment	Online	Employers continuing to advanced TA	Baseline (starting Sept 2015) and 7 months post-baseline (starting April 2016)	Assess employers’ readiness to apply for workplace health accreditation by examining aspects of their workplace health program that are required for accreditation. The assessment will be used to tailor technical assistance provided to the employer.	Items to assess employers’ workplace health program and policies in the following areas: Organizational Alignment Population Health Management, Data Collection, Outcomes and Reporting
Advanced TA Survey	Online	Employers continuing to advanced TA	3 months (starting Dec 2015) and 7 months post-baseline (starting April 2016)	Assess the use and effectiveness of advanced technical assistance and peer learning networks	Utility of different aspects of the technical assistance (e.g., topical webinars, interactive discussions with peers and facilitators) Ability to transfer what was learned to workplaces and others
Follow-up Accreditation Survey	Online	Employers continuing to advanced TA	10 months post-baseline (starting July 2016)	Determine whether participants have been able to apply for and receive accreditation.	List of accreditations applied for, dates and results of each Barriers to applying for accreditation Plans for applying in the future
Train-the-Trainer Application Form	Online	Interested employers, trainers, and/or facilitators	Prior to training (starting Summer 2015)	- Select participants for the Train-the-Trainer model of the Work@Health Program		Applicants’ contact information Information about applicants’ place of work Experience in training facilitation, leadership in an organization implementing a workplace health program Personal statement
Train-the-Trainer Knowledge and Skills Survey	Online	Trainees participating in Train-the-Trainer model	1 month prior to training (starting Dec 2015) and 6 months post training (starting June 2016)	- Assess facilitation skills and the ability to train others -Assess knowledge about workplace health programs and policies		Workplace health knowledge scale Self-rate strength of facilitation skills Preparation and confidence in training others in workplace health programs
Employer Follow-up Survey	Telephone	Employer graduates of Work@Health	Annually	Assess program maintenance and sustainability Determine to what extent each employer is continuing to implement the Work@Health elements		Changes to employers’ programs Barriers encountered Lessons learned after formal Work@Health participation has ended

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