Annual Case Study

Form Approved
OMB No. 0920-xxxx
Exp. Date xxxx/20xx

Workplace Wellness Grant Program
Annual Case Study
The case study is due one year from the date we issue the grant check. The case study assesses the impact of wellness
on workplace safety and the frequency and severity of workers' compensation claims. It also, helps us identify best
practices for the implementation of workplace wellness programs. Completion and a timely submission of the case study
is required to receive funding for the next year.
Please answer all the questions and email to [email protected], or mail to Workplace Wellness Grant
Program, Division of Safety & Hygiene, 13430 Yarmouth Drive, Pickerington, OH, 43147-8310. We will send you a letter
outlining next steps upon receipt and review of your case study.

I.
A. Provide the following employer/employee information:
1. Company name and BWC policy number;
2. Number of employees in the company;
3. Number of employees who voluntarily left employment with your organization during the calendar year;
4. Number of employees who participated in the wellness program. Include employees who completed the
biometric screening and the health risk appraisal(HRA) in addition to participating in at least one
program;
5. Percentage of wellness program participants who are male;
6. Percentage of wellness program participants who are female;
7. Percentage of wellness program participants who fall within the following age categories;
a. 15-24; _______%
b. 25-34; _______%
c. 35-44; _______%
d. 45-54; _______%
e. 55-64; _______%
f. 65-74; _______%
g. 75+. _______%
B. Wellness program information
1. What elements, if any, of an effective workplace wellness program did you follow?
Collect data through surveys
Collect data through screenings
Continuously evaluate and improve the program
Develop a wellness team or appoint a wellness coordinator
Develop a written wellness program
Identify and deliver health promotion programs and services
Include a wellness plan in the business operations plan
Obtain senior leadership commitment
C. How is your organization evaluating the effectiveness of your wellness program?
Coaching participation rates
Improvement in aggregate biometric/health risk appraisal measures
Improvement in participant satisfaction with job/work
Improvement in participant satisfaction with the wellness program
Productivity improvements
Program participation rates
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Public reporting burden of this collection of information is estimated to average 30 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 aspects of this collection of information, including suggestions for
reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333; ATTN: PRA (0920-xxxx).

Reduction in absenteeism
Reduction in healthcare utilization costs
Reduction in turnover
Reduction in workers’ compensation costs
2. How did you use the HRA and biometric data to design your workplace wellness program?
3. Describe wellness training provided and attendance rates.
4. Describe wellness coaching provided and participation rates.
5. What benefits have you seen?
6. What challenges did you face this year regarding your wellness program?
Concerns about confidentiality of health data
Concerns about legal issues
High employee turnover
Lack of awareness regarding wellness program benefits
Lack of financial resources
Lack of human resources
Lack of upper management support
Low employee interest or participation
Low to no return-on-investment (ROI)
No difficulties
Remote work locations
Union contract restrictions
Other: Please explain.

7. What are your goals for next year?
D. Please provide the following additional information to receive funding for next year.
a. You must submit the aggregate biometric screening and HRA data as well as the employee data to BWC
within the first three months of the participating program year to receive funds.
b. Are you remaining with the same wellness program vendor for the next year's wellness grant program
participation?
Yes or
No
If yes, please provide us with a confirmation statement to that effect. If not, please provide us with a
contract from your new vendor.

c. How satisfied were you with your wellness vendor?
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
d. What did you like most about your wellness vendor?
e. What did you like least about your wellness vendor?

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Dissatisfied

Very dissatisfied

II.
Workplace wellness programs reduce workers’ unhealthy lifestyle habits (e.g. tobacco use, poor nutrition, lack of
physical activity).
Safety programs prevent work-related injuries and illnesses by reducing workers’ exposure to occupational risk
factors (e.g. ergonomic, chemical, and biologic).
Please select the best answers to the questions below about your workplace wellness and safety programs.
Please indicate which programs your Workplace Wellness Program Grant funded last year? Please
check all that apply.
Biometric screenings
Educational seminars on improving health
Group Health counseling/coaching
Health risk appraisals
Individual health counseling/coaching
Nutritional counseling
Physical fitness activities
Smoking cessation program
Stress management program
Weight loss management program
Other(s). Please list ____________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

Beyond the activities funded by your Workplace Wellness Program Grant, what else did your
organization do to support your wellness program? Please check all that apply.
Biometric health screenings
Cancer screening
Diabetes screening
Educational seminars on improving health
Extended the Workplace Wellness Program to more than the employees funded by the BWC Grant
Flu vaccinations
Group Health counseling/coaching
Health fair
Health risk appraisals
Implemented a policy prohibiting smoking on premises or in company vehicles
Improved disability management policies and practices to promote timely return-to-work after injury or
illness
Made changes to reduce chemical or biologic exposures (e.g. improved ventilation, etc.)
Made changes to reduce physical workload or ergonomic stresses at work (e.g. reduce overexertion
with material handling equipment)
Made changes to reduce safety hazards at work (e.g. provide controls to reduce falls)
Made facility changes to promote physical fitness (e.g. providing showers, exercise equipment or
area)
Made facility changes to provide comfortable and quiet break rooms
Made scheduling changes to promote physical fitness and work-life balance (e.g. flexible work hours)
Made vending machine changes to promote healthy eating habits
Made work organization changes to empower employees by giving them more control over their work
Nutritional counseling
Personal Health counseling/coaching
Physical fitness activities
Provided financial benefits for wellness participation-(e.g. reduced health insurance premiums)
Provided funding support for gym memberships
Provided healthy food choices at company sponsored events
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Smoking cessation program
Sponsored healthy weight-loss contests
Sponsored or supported social exercise activities (e.g. sport teams, lunchtime exercise)
Started an employee assistance program (for psychological and substance abuse issues)
Stress management program
Weight loss management program
Other(s). Please list ____________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Made no additional changes to promote employee wellness
Do you have any groups at your workplace that plan or evaluate safety or wellness activities?
(Choose one answer)
No, we have no groups or committees for safety or wellness.
Yes. We have a group for safety only.
Yes. We have a group for wellness only.
Yes. We have groups for both safety and wellness, and these are separate groups/committees.
Yes. There is one group or committee that deals with both safety and wellness (or 2 different groups but
the members are almost the same).
Does your company jointly monitor safety and employee wellness by gathering together information on both?
For example, combining information on workers’ compensation claims or safety inspections with information on
the health of your employees.
No, we review our data on work safety, but we don’t look at wellness information at the same time.
We have looked at safety and employee wellness data at the same time, but not on a regular basis.
We regularly put together our information on safety and employee wellness
Within the past year, how often have safety and workplace wellness program topics been included in the same
communication materials or training sessions?
Never
Occasionally
Often
When you designed your workplace wellness program, which of the following factors influenced the program’s
design (if any)? Please focus on whether you made specific choices about what to include in the program or
how to implement it, based on the factors listed below. Please check all that apply.
Employee age range
Employee work schedules (work breaks, time constraints, overtime, flexible schedules)
Ergonomic hazards at your workplace (e.g., manual material handling)
Exposure to hazardous substances (e.g. chemical, biological)
Physical safety hazards at your workplace (e.g. fall hazards, motor vehicle accidents)
Shift work at your workplace (e.g. night, rotating)
Social work environment and company culture
Specific employee health interests or concerns
Workers’ compensation claims history
Work stress among your employees
Your employee biometric measures (e.g. weight, blood pressure, cholesterol)
Your employee health behavior data (e.g. with health risk appraisal data)
Other workplace-specific factors (please be specific)
_______________________________________________________________________________________
_______________________________________________________________________________________

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Exercise
Consider whether there are barriers in the following categories that make it difficult to exercise.
For each work factor listed below, please indicate whether you: Strongly agree; somewhat agree; neither
agree nor disagree; somewhat disagree; strongly disagree.

Work schedule (e.g. shiftwork, overtime, inadequate work breaks) makes it difficult to exercise
Strongly agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

Lack of facilities or equipment at work (e.g. workout room, equipment, showers) makes it difficult to
exercise
Strongly agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

Lack of facilities near work (e.g. gym or place to walk) makes it difficult to exercise
Strongly agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

Physically demanding work leads to tiredness or fatigue that makes it difficult to exercise
Strongly agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

Nature of work causes aches and pains, or sometimes injuries that make it difficult to exercise
Strongly agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

Work stress (e.g. work pressure, anxiety, or mental fatigue) makes it difficult to exercise
Strongly agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

Other work factor(s) that makes it difficult to exercise (Specify: _____________________________________)
Considering the responses above, is there anything that you think you can do (or have done) to overcome or reduce this
difficulty? If yes, can you briefly describe the best example, and indicate whether this is something you’re doing already or
will be considered for the future?

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Healthy eating
Consider whether there are barriers in the following categories that make it difficult to eat healthy.
For each work factor listed below, please indicate whether you: Strongly agree; somewhat agree; neither
agree nor disagree; somewhat disagree; strongly disagree.

Work schedule (e.g. shiftwork, overtime, inadequate work breaks) makes it difficult to eat healthy

Strongly agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

Lack of healthy food choices at the workplace makes it difficult to eat healthy

Strongly agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

Lack of healthy food options near the workplace makes it difficult to eat healthy

Strongly agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

Somewhat disagree

Strongly disagree

Physically demanding work makes it difficult to eat healthy

Strongly agree

Somewhat agree

Neither agree nor disagree

Work stress (e.g. mental fatigue or distraction) makes it difficult to eat healthy

Strongly agree

Somewhat agree

Neither agree nor disagree

Somewhat disagree

Strongly disagree

Other work factor(s) that makes it difficult to eat healthy (Specify: ___________________________________)
Considering the responses above, is there anything that you think you can do (or have done) to overcome or reduce
this difficulty? If yes, can you briefly describe the best example, and indicate whether this is something you’re doing
already or will be considered for the future?

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For the person in your company responsible for implementing your workplace wellness program and safety
program (which may be you), please indicate the primary and other areas of responsibility for each person:
If the same person is responsible for your organizations’ safety and wellness programs check this box and fill out
only the Workplace Wellness Program columns below.
Workplace Wellness
Program
Area of responsibility

Main job
(mark one)

Other
(mark any)

Occupational Safety and
Health Program
Main job
(mark one)

Other
(mark any)

Safety
Human resources
Wellness
Senior management
(e.g. President, Owner, CFO, etc.)
Other hourly
(please specify)
Other salaried
(please specify)
In the last year, think about all other employees (if any) who contributed to major decisions that affected the
design or implementation of your workplace wellness program. What are their main areas of responsibility?
Please check all that apply.
Human resources
Safety
Senior management (e.g. President, Owner, CFO, etc.)
Wellness
Other hourly - please specify occupation(s). _________________________________________________
Other salaried - please specify occupation(s) ________________________________________________
No one else contributed
Are you? (check all that apply)

The main person responsible for your occupational safety program
The main person responsible for your workplace wellness program
Neither

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