Attachment C-7_CDC_Worksite_Health Scorecard Summary of Revisions_6-26-17

CDC Worksite Health Scorecard Summary of Revisions and Updates

Organizational Supports
Overall Module Key Yellow shaded boxes indicate revisions in the wording of the question or scoring changes have occurred between versions of the Scorecard. Blue shaded boxes indicate a new question that has been added between versions of the Scorecard. Red shaded boxes indicate the question has been deleted from the prior version to the updated version of the Scorecard. Clear boxes with no shading indicate the question has been retained between versions of the Scorecard without any change.
Question Text in the 2014 Health ScoreCard	Proposed Revised Text for the Updated Health ScoreCard1	New (Old) Score	Notes / Justification
Conduct an employee needs and interests assessment for planning health promotion activities? Answer “yes” if, for example, your organization administers focus groups or employee satisfaction surveys to assess your employee health promotion program(s). Answer “no” if your organization administers general surveys that do not assess your employee health promotion program(s).	Conduct an employee needs and interest survey for planning health promotion activities? Answer “yes” if, for example, your organization administers surveys or conducts focus groups to assess your employees’ readiness, motivation, or preferences for health promotion programs. [1] Measurement and Evaluation [7]	1 (1)	Removed portion of subtext related to a “no” response to focus on the positive aspects of the employers’ programs and increase consistency with all other questions.
Conduct employee health risk appraisals/assessments through vendors, on-site staff, or health plans and provide individual feedback plus health education? Answer “yes” if, for example, your organization provides individual feedback through written reports, letters, or one-on-one counseling.	Conduct employee health risk appraisals (HRAs) or health assessments (HAs) and provide individual feedback plus health education resources for follow-up action? Answer “yes” if, for example, your organization conducts HRAs through vendors, on-site staff, or health plans and provides individual feedback through written reports, letters, or one-on-one counseling. [2] Measurement and Evaluation [8]	3 (3)	Subtext expanded to provide more education about the various methods such surveys could be conducted.
Demonstrate organizational commitment and support of worksite health promotion at all levels of management? Answer “yes” if, for example, all levels of management participate in activities, communications are sent to employees from senior leaders, the worksite supports performance objectives related to healthy workforce, or program ownership is shared with all staff levels.	Demonstrate organizational commitment and support of worksite health promotion at all levels of management? Answer “yes” if, for example, all levels of management participate in activities, send communications to employees, or have performance objectives related to a healthy workforce. [3] Leadership Commitment and Support [1]	2 (2)	Verbiage simplified to focus on management.
Use and combine incentives with other strategies to increase participation in health promotion programs? Answer “yes” if, for example, your organization offers incentives such as gift certificates, cash, paid time off, product or service discounts, reduced health insurance premiums, employee recognition, or prizes.	Use and combine incentives with other strategies to increase participation in health promotion programs? Answer “yes” if, for example, your organization offers incentives such as gift certificates, cash, paid time off, product or service discounts, reduced health insurance premiums, employee recognition, or prizes. [4] Participation and Engagement [13]	2 (2)
Use competitions when combined with additional interventions to support employees making behavior changes? Answer “yes” if, for example, your organization offers walking or weight loss competitions.	Use individual or team competitions or challenges in combination with additional interventions to support employees making behavior changes? Answer “yes” if, for example, your organization offers physical activity competitions. [5] Participation and Engagement [14]	2 (2)	Expanded the question to show that competition-style aspects can be individual or team-based. Removed weight loss as a primarily example in the subtext due to evidence that the long term health effects are not always positive.
Promote and market health promotion programs to employees? Answer “yes” if, for example, your worksite’s health promotion program has a brand name or logo, uses multiple channels of communication, or sends frequent messages.	Promote and market health promotion programs to employees? Answer “yes” if, for example, your worksite’s health promotion program has a brand name or logo or uses multiple channels of communication to inspire and connect employees to health promotion resources. These may include sharing employees’ health-related "success stories." [Combined/modified 6 & 7] Strategic Communications [10]	2 (2)	Combined original questions 6 and 7 due to their overall similarity, and the low evidence-base for the use of success stories alone.
Use examples of employees role modeling appropriate health behaviors or employee health-related “success stories” in the marketing materials?	<DELETE>	0 (1)	Combined with original question 6 due to low evidence-base, in addition because the question was viewed as a sub-question to question 6 by the participating SMEs.
Tailor some health promotion programs and education materials to the language, literacy levels, culture, or readiness to change of various segments of the workforce? Answer “no” if you do not perceive a need for your organization to tailor its health promotion programs and education materials to any specific group(s).	Use tailored health promotion communications to ensure that they are accessible and appealing to employees of different ages, genders, education levels, job categories, cultures, languages, or literacy levels? [8] Strategic Communications [11]	3 (3)	Removed “no” subtext to emphasize that tailoring should not be considered an optional aspect of any program. Note: there was considerable discussion regarding whether this item should or should not be included in the HSC, as there is not a similar question in other tools (e.g., HERO, WHA) and because the question is constructed in a negative way rather than in a format that rewards positive behaviors.
Have an active health promotion committee? Answer “yes” if your health promotion committee exists and has been involved in planning and implementing programs.	Have an active and diverse health promotion committee? Answer “yes” if, for example, your health promotion committee is routinely engaged in planning and implementing programs, and includes workers from all levels of the organization, various departments, as well as representatives from special groups (e.g., remote workers, organized labor). [9] Leadership Commitment and Support [5]	2 (2)	Enhanced subtext description based on SME feedback.
Have a paid health promotion coordinator whose job (either part-time or full-time) is to implement a worksite health promotion program? Answer “yes” if implementing the employee health promotion program(s) at your worksite is included in a paid staff member’s job description or performance expectations.	Have a paid health promotion coordinator whose job (either part-time or full-time) is to manage the worksite health promotion program? Answer “yes” if the staff member is located on or offsite and has responsibility for health promotion as part of his or her job description or performance expectations. [10] Leadership Commitment and Support [6]	2 (2)	Added onsite/offsite because not every worksite has a dedicated person in-house, and because this would be unfeasible for most worksites particularly smaller employers.
Have a champion(s) who is a strong advocate for the health promotion program? Answer “yes” if there is someone at your worksite who actively promotes programs to improve worksite health promotion.	Have a champion or network of champions who actively promote health promotion programs? [11] Participation and Engagement [12]	2 (2)	“Network of champions” was added to the question root based on SME suggestion to emphasize the important role of champions, including that they do not necessarily have to be senior leadership but can be employees at all levels.
Have an annual budget or receive dedicated funding for health promotion programs?	Have an annual budget or receive dedicated funding for health promotion programs? [12] Leadership Commitment and Support [4]	2 (2)
Set annual organizational objectives for health promotion?	Have a strategic plan that includes goals and measureable organizational objectives for the health promotion program? Answer “yes” if, for example, your organization identifies SMART (i.e., specific, measurable, achievable, realistic, time bound) goals and objectives. [13] Leadership Commitment and Support [3]	2 (2)	Incorporated subtext to offer more precise educational guidance for an evidence-based approach to measuring and incorporating WHP into organizational objectives.
Include references to improving or maintaining employee health in the business objectives or organizational mission statement? Answer “no” if your organization’s business objectives or mission statement only reference occupational health and safety, without reference to improving the workforce’s health.	Include references to improving or maintaining employee health and safety in the business objectives, core values, or organizational mission statement? [Combined/modified 14 & 107] Leadership Commitment and Support [2]	1 (1)	Questions 14 and 107 (from the Occupational Health & Safety Module) were determined to be closely overlapping and potentially redundant, offering an opportunity for additional “points” without representing additional provisions or programs for improving employee health or safety. Removed the “Answer “no” subtext—the consensus was that it was unnecessary, as well as inconsistent with the approach taken in other questions.
Conduct ongoing evaluations of health promotion programming that use multiple data sources? Answer “yes” if, for example, your organization collects data on employee health risks, medical claims, employee satisfaction, or organizational climate surveys.	Conduct ongoing evaluations of health promotion programming that use multiple data sources to inform decision-making? Answer “yes” if, for example, your organization routinely measures the quality and impact of health promotion programs. This may be measured using data on employee health risks, medical claims, employee satisfaction, or organizational climate surveys. [15] Evaluation and Measurement [9]	2 (2)
Make any health promotion programs available to family members?	Make health promotion programs available to family members? Answer “yes” if, for example, your organization allows employees’ family members access to health assessments, fitness facilities, on-site medical clinics, or wellness competitions. [16] Programs, Policies, and Environmental Supports [23]	1 (1)	Subtext was added to enhance the educational component of the tool.
Provide flexible work scheduling policies? Answer “yes” if, for example, policies allow for flextime schedules and work at home.	Provide and support flexible work scheduling policies? Answer “yes” if, for example, policies allow for flextime schedules, the option to work at home, or allowing time during the day for employees to engage in health promotion activities. [17] Programs, Policies, and Environmental Supports [21]	2 (2)
Engage in other health initiatives throughout the community and support employee participation and volunteer efforts? Answer “yes “if, for example, your organization supports participation in community events and school-based efforts, such as corporate walks, collaborate with state and local advocacy groups, health and regulatory organizations, and coalitions.	Support employee volunteerism? Answer “yes “if, for example, your organization supports participation in community events, such as corporate walks or school-based efforts. [18] Participation and Engagement [15]	1 (2)	The subtext was modified to be more general, with “advocacy groups” and “regulatory organizations” specifically removed based on SME and CDC feedback. Both the evidence base and impact ratings were reduced by 1 point each, leading to the adjusted rating decreasing from 2 to 1 point. This change reflected both Truven/JHU recommendations and SME agreement that the overall evidence was not in alignment with the previous ratings.
	Implement or maintain healthy building design principles? Answer “yes” if, for example, your worksite provides access to windows and natural light, communal spaces, and plants. [New] Participation and Engagement [16]	1 (0)	This new question is based on emerging evidence that worksite design can improve employee health by, among other things, reducing stress, encouraging positive social interactions, and increasing positive health behaviors.
	Extend access to key components of the program to all workers, including hard to reach workers (e.g., telecommuters, contract workers, night shift workers, part-time workers)? Answer “yes” if, for example, your organization offers alternative options for participating in programs or services, such as 24-hour gym access or virtual access to lectures. [New] Participation and Engagement [17]	1 (0)	This new question was proposed in response to the ever increasing diversity of employment situations, and in particular to reinforce the need for worksite health promotion programs to be designed and implemented in ways that promote equal access to benefits and services.
	Provide an employee assistance program (EAP)? Answer “yes” if, for example, employees have access to an EAP that offers services addressing financial health, depression, stress management, grief counseling, substance use, and other mental and emotional health issues. [New] Programs, Policies, and Environmental Supports [18]	2 (0)	This question was proposed based on conversations that emphasized the need to better integrate/address EAP offerings during several panels, including the Stress Management, Depression, and Substance Use module meetings. Because of the cross-cutting nature of EAP services, this suggested question was added to only the Organizational Supports module rather than as a question within each of these modules. This decision was made to avoid “double counting” or artificially increasing scores.
	Implement educational programming to improve health care consumerism? Answer “yes” if, for example, your organization provides employees with written or interactive guidance on improving doctor-patient relationships, promoting patient-centered care, and appropriate use of medical resources. [New] Programs, Policies, and Environmental Supports [19]	1 (0)	This new question is based on evidence that employers can play an active role in helping their employees make full use of available services and benefits, including through enhancing health literacy.
	Educate employees about preventive services and benefits covered by their health insurance plan on an ongoing basis, above and beyond what occurs during annual health insurance enrollment? Answer “yes” if, for example, your worksite communicates information about benefits such as smoking cessation medication and counseling, weight management tools, and flu vaccinations through emails or newsletters that are distributed across the calendar year. [New] Programs, Policies, and Environmental Supports [20]	1 (0)	This question was added subsequent to the SME panel meetings, in order to further emphasize the role that employers can play in promoting and encouraging the use of health insurance benefits.
	Provide work-life balance programming and resources? Answer “yes” if, for example, your worksite provides resources related to elder care, child care, tuition reimbursement or financial counseling. [65] Programs, Policies, and Environmental Supports [22]	3 (3)	This question was previously part of the Stress Management module. It was moved here after discussions that, like EAP, the program offerings cut across modules and represent general opportunities to promote worker health and well-being.
	Offer all benefits-eligible employees paid time off for days or hours absent due to illness, vacation, or other personal reasons (including family illness or bereavement)? Answer “yes” if, for example, paid time off, not including paid parental leave, is provided to all benefits-eligible employees. [Combined/modified 116A & 116B] Programs, Policies, and Environmental Supports [24]	1 (0)	A two-part form of this question was previously part of the Occupational Health and Safety module. It was moved to the Organizational Supports module because time off was viewed more as a general support and/or benefit than as a part of the specific health and safety culture. The adjusted score did not change. The prior question separated sick/illness time from vacation time. Here it is combined to reflect a more general move towards combined PTO.
	Coordinate programs for occupational health and safety with programs for health promotion and wellness? Answer “yes” if, for example, these departments have common strategy, routine data sharing, regular meetings across functions, and warm handoff referrals. [115] Programs, Policies, and Environmental Supports [25]	2 (2)	This question was previously in the Occupational Health and Safety module. It was moved here to emphasize the importance of integration across program types.
Total Possible Points		44 (33)

Tobacco Use

Question Text in the 2014 Health ScoreCard	Proposed Revised Text for the Updated Health ScoreCard	New (Old) Score	Notes / Justification
Have a written policy banning tobacco use at your worksite? Answer “yes” if your worksite adheres to a statewide, countywide, or citywide policy banning tobacco use in the workplace.	Have and promote a written policy banning tobacco use at your worksite? Answer “yes” if, for example, your policy covers cigarettes and/or other tobacco products and is communicated to employees regularly through emails, newsletters, or signage in public places. [19] [1]	3 (3)	“And promote” was added across all modules to policy questions to emphasize that these policies are only effective when employees are aware and know how to access benefits. The subtext was revised due to the place-based nature of tobacco use policies and that such requirements are under legal mandates rather than simply under the prevue of the employer. The revised subtext is also meant to invoke the idea that employers can go beyond legally-mandated tobacco-related policies if they so choose, as well as to additionally emphasize that tobacco use can include modalities other than cigarettes. There was much discussion over whether the term should be “smoking” or “smoke free”.
Actively enforce a written policy banning tobacco use? Answer “yes” if, for example, your worksite posts signs, does not have ashtrays, or communicates this written policy banning tobacco use through various channels at your worksite.	<DELETE>	0 (1)	The intent of this question as indicated by the original subtext is now captured by two separate questions (below) on educational materials and interactive educational programming that reinforce the policies and provide guidance.
Display signs (including ‘no smoking’ signs) with information about your tobacco-use policy?	<DELETE>	0 (1)	This question was deemed to be redundant to Q19.
Refer tobacco users to a state or other tobacco cessation telephone quit line? Answer “yes” if, for example, your worksite refers tobacco users to 1-800-QUIT NOW or smokefree.gov.	Provide educational materials that address tobacco cessation? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters on tobacco cessation, including referral to 1-800-QUIT NOW or smokefree.gov, either as a single health topic or along with other health topics. [New, elements of 22] [2]	1 (3)	The root question text was modified to improve alignment with other modules while incorporating elements of the original subtext. The adjusted value of the question decreased from 3 points to 1 point. This change reflects not only the division of passive versus active educational programming, but also a reassessment of the published evidence base.
Provide health insurance coverage with no or low out-of-pocket costs for prescription tobacco cessation medications including nicotine replacement? Answer “yes” if, for example, your organization provides coverage for inhalers, nasal sprays, bupropion (e.g., Zyban) and varenicline (e.g., Chantix).	Provide health insurance coverage with free or subsidized out-of-pocket costs for FDA-approved prescription tobacco cessation medications? Answer “yes” if, for example, your organization provides coverage for inhalers, nasal sprays, bupropion (e.g., Zyban) and varenicline (e.g., Chantix). [23] [7]	3 (3)
Provide health insurance coverage with no or low out-of-pocket costs for FDA-approved over-the-counter nicotine replacement products? Answer “yes” if, for example, your organization provides coverage for nicotine replacement gum, patches, or lozenges.	Provide health insurance coverage with free or subsidized out-of-pocket costs for FDA-approved over-the-counter nicotine replacement products? Answer “yes” if, for example, your organization provides coverage for nicotine replacement gum, patches, or lozenges. [24] [8]	2 (2)
Provide or promote free or subsidized tobacco cessation counseling? Answer “yes” if these programs are provided on- or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.	Provide and promote free or subsidized lifestyle coaching/counseling or self-management programs that equip employees with skills and motivation to quit using tobacco? Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. This may include referral to 1-800-QUIT-NOW or smokefree.gov. [25] [4]	3 (2)	“And promote” was added to the root of several questions across modules to emphasize that policies in and of themselves do not achieve results. The subtext was updated to ensure that it encompassed newer forms of interactive technology, as well as referral to 1-800-QUITNOW. The adjusted value of the question increased from 2 to 3 points, reflecting the availability of new evidence.
Inform employees about health insurance coverage or programs that include tobacco cessation medication and counseling?	<DELETE>	0 (2)	This question was deleted to be consistent with other modules. While many other modules have insurance questions, this was the only module to include a question on informing employees about benefits.
Provide incentives for being a current nonuser of tobacco and for current tobacco users that are currently involved in a cessation class or actively quitting? Answer “yes” if, for example, your organization provides discounts on health insurance, or other benefits for non-smokers and tobacco users who are actively trying to quit.	Provide financial incentives for being a current non-smoker and for current smokers who are actively trying to quit tobacco by participating in a free or subsidized, evidence-based cessation program? Answer “yes” if, for example, your organization provides discounts on health insurance, additional life insurance for non-smokers, or other benefits for non-smokers and smokers who are actively trying to quit. [27] [6]	3 (1)	The evidence and impact ratings were both increased based on the review of new and emerging evidence. “financial” added to main question text, since all the evidence relates to financial incentives (not knickknacks or psychic benefits).
Do not allow sale of tobacco products on company property? Answer “yes” if, for example, your worksite does not sell tobacco products on company property in vending machines or through on-site vendors.	Prohibit the sale of tobacco products on company property? [28] [5]	1 (1)
	Provide and promote interactive educational programming on tobacco cessation? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes on tobacco cessation. These programs may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [New] [3]	2 (2)	This new question was added to more closely align the module with the format of the rest of other modules that distinguished between more passive and more active types of educational programming. A subsequent review of the evidence and impact of this intervention was clear and strong, further substantiating its addition to the module. “And promote” is included to emphasize that policies in and of themselves do not achieve results.
Total Possible Points		18 (19)

High Blood Pressure
Question Text in the 2014 Health ScoreCard	Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score		Notes / Justification
Provide free or subsidized blood pressure screening (beyond self-report) followed by directed feedback and clinical referral when appropriate?	Provide free or subsidized blood pressure screening (beyond self-report) followed by directed feedback and clinical referral when appropriate? [75] [1]			3 (3)
Provide brochures, videos, posters, pamphlets, newsletters, or other written or online information that address the risks of high blood pressure? Answer “yes” if these health promotion materials address the risks of high blood pressure as a single health topic or if the risks of high blood pressure are included with other health topics.	Provide educational materials on preventing and controlling high blood pressure? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters that address high blood pressure/pre-hypertension, either as a single health topic or along with other health topics. [76] [2]			1 (1)		The root question text was edited in alignment with questions in other modules.
Provide a series of educational seminars, workshops, or classes on preventing and controlling high blood pressure? Answer “yes” if these sessions address preventing or controlling high blood pressure as a single health topic or if preventing and controlling high blood pressure are included with other health topics. These sessions can be provided in-person or online; on-site or off- site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.	Provide and promote interactive educational programming on preventing and controlling high blood pressure? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes that address high blood pressure/pre-hypertension. These programs may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [77] [3]			3 (3)		The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies and programs in and of themselves do not achieve results.
Provide one-on-one or group lifestyle counseling and follow-up monitoring for employees with high blood pressure or pre- hypertension? Answer “yes” if these programs are provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.	Provide and promote free or subsidized lifestyle coaching/counseling or self-management programs that equip employees with skills and motivation to set and meet their personal blood pressure management goals? Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [COMBINED 78 & 79] [4]			3 (3)		The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies and programs in and of themselves do not achieve results.
Provide free or subsidized self-management programs for blood pressure control and prevention? Answer “yes” if these programs are provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.	<DELETE>			0 (3)		This question was merged with the previously existing question about counseling and other follow-up services (original question 78). A similar change was made across modules.
Make blood pressure monitoring devices available with instructions for employees to conduct their own self assessments?	Make blood pressure monitoring devices available with instructions for employees to conduct their own self assessments? [80] [5]			3 (2)		The adjusted value of the question was increased from 2 to 3 points reflecting newly identified evidence.
Provide health insurance coverage with no or low out-of-pocket costs for blood pressure control medications?	Provide health insurance coverage with free or subsidized out-of-pocket costs for blood pressure control medications? [81] [6]			3 (2)		The adjusted value of the question was increased from 2 to 3 points reflecting newly identified evidence and SME recommendations regarding the benefits of health insurance coverage for this condition.
Total Possible Points				16 (17)

High Cholesterol
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Provide free or subsidized cholesterol screening (beyond self- report) followed by directed feedback and clinical referral when appropriate?		Provide free or subsidized cholesterol screening (beyond self-report) followed by directed feedback and clinical referral when appropriate? [82] [1]			3 (3)
Provide brochures, videos, posters, pamphlets, newsletters, or other written or online information that address the risks of high cholesterol? Answer “yes” if these health promotion materials address the risks of high cholesterol as a single health topic or if the risks of high cholesterol are included with other health topics.		Provide educational materials on preventing and controlling high cholesterol? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters that address high cholesterol, either as a single health topic or along with other health topics. [83] [2]			1 (1)	The root question text was edited in alignment with questions in other modules.
Provide a series of educational seminars, workshops, or classes on preventing and controlling high cholesterol? Answer “yes” if these sessions address preventing and controlling high cholesterol as a single health topic or if preventing and controlling high cholesterol are included with other health topics. These sessions can be provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		Provide and promote interactive educational programming on preventing and controlling high cholesterol? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes that address high cholesterol. These programs may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [84] [3]			3 (3)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies and programs in and of themselves do not achieve results.
Provide one-on-one or group lifestyle counseling and follow-up monitoring for employees who have high cholesterol? Answer “yes” if these programs are provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		Provide and promote free or subsidized lifestyle coaching/counseling or self-management programs that equip employees with skills and motivation to set and meet their personal cholesterol management goals? Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [COMBINED 85 & 86] [4]			3 (3)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies and programs in and of themselves do not achieve results.
Provide free or subsidized self-management programs for cholesterol or lipid control? Answer “yes” if these programs are provided in-person or online; on- site or off-site; in group or individual settings; through vendors, on- site staff, health insurance plans and programs, community groups, or other practitioners.		<DELETE>			0 (3)	This question was merged with the previously existing question about counseling and other follow-up services (original question 85). A similar change was made across modules.
Provide health insurance coverage no or low out-of-pocket costs for cholesterol or lipid control medications?		Provide health insurance coverage with free or subsidized out-of-pocket costs for cholesterol or lipid control medications? [87] [5]			3 (2)	The adjusted value of the question was increased from 2 to 3 points reflecting newly identified evidence and SME recommendations regarding the benefits of health insurance coverage for this condition.
Total Possible Points					13 (15)

Physical Activity
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Provide an exercise facility on-site?		Provide an exercise facility on site? [48] [4]			1 (3)	After much discussion, SMEs recommended that the phrase “exercise facility” remain in the root of the question. The adjusted value of this question was decreased from 3 to 1 because of the lack of strong evidence supporting effectiveness.
Subsidize or discount the cost of on-site or offsite exercise facilities?		Subsidize or discount the cost of on or off site exercise facilities? [49] [5]			1 (3)	The adjusted value of this question was decreased from 3 to 1 because of the lack of strong evidence supporting effectiveness.
Provide environmental supports for recreation or physical activity? Answer “yes” if, for example, your worksite provides trails or a track for walking/jogging, maps of suitable walking routes, bicycle racks, a basketball court, open space designated for recreation or exercise, a shower and changing facility.		Provide or promote other environmental supports for recreation or physical activity? Answer “yes” if, for example, your worksite provides trails or a track for walking/jogging, maps of suitable walking routes, a basketball court, treadmill workstations, sit-stand workstations, lockers, a shower, or changing facility. [50] [6]			3 (3)	“Promote” was added to the root of several questions across modules to emphasize that results are achieved only if it is clear that these items are available.
Post signs at elevators, stairwell entrances or exits and other key locations that encourage employees to use the stairs? Answer “no” if your worksite is located in a one-story building.		Post signs at elevators, stairwell entrances and other key locations and use design enhancements to encourage employees to use the stairs? Design enhancements may include artwork, music, and good lighting in stairwells. [51] [7]			3 (3)	The subtext was adjusted to broaden the applicability of this question to all worksites, as the evidentiary basis was not restricted to multi-story buildings.
Provide organized individual or group physical activity programs for employees (other than the use of an exercise facility)? Answer “yes” if, for example, your worksite provides walking or stretching programs, group exercise, or weight training.		Provide and promote organized physical activity programs for employees (other than the use of an exercise facility)? Answer “yes” if, for example, your worksite organizes walking groups, stretching programs, group exercise classes, recreational leagues, or buddy systems to create supportive social networks for physical activity. [52] [8]			3 (3)	“And promote” was added across all modules to policy questions to emphasize that these policies are only effective when employees are aware and know how to access benefits.
Provide brochures, videos, posters, pamphlets, newsletters, or other written or online information that address the benefits of physical activity? Answer “yes” if these health promotion materials address the benefits of physical activity as a single health topic or if the benefits of physical activity are included with other health topics.		Provide educational materials that address the benefits of physical activity? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters that address the benefits of physical activity, either as a single health topic or along with other health topics. [53] [1]			1 (1)	The root question text was edited in alignment with questions in other modules.
Provide a series of educational seminars, workshops, or classes on physical activity? Answer “yes” if these sessions address physical activity as a single health topic or if physical activity is included with other health topics. These sessions can be provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		Provide and promote interactive educational programming on physical activity? Answer “yes” if, for example, your worksite offers timely reminders/prompts to move, or “lunch and learns,” seminars, workshops, or classes that teach and promote physical activity. These programs may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [54] [2]			2 (2)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies in and of themselves do not achieve results.
Provide or subsidize physical fitness assessments, follow-up counseling, and physical activity recommendations either on-site or through a community exercise facility?		Provide and promote free or subsidized lifestyle coaching/counseling or self-management programs that equip employees with skills and motivation to set and meet their personal physical activity goals? Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [55 & 56] [3]			3 (3)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies in and of themselves do not achieve results.
Provide free or subsidized self-management programs for physical activity? Answer “yes” if these programs are provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		<DELETE>			0 (3)	This question was merged with the previously existing question about counseling and other follow-up services (original question 55). A similar change was made across modules.
		Provide or promote the use of activity trackers to support physical activity? Answer “yes” if, for example, your worksite provides or subsidizes the cost of pedometers, wearable trackers, online tools, or mobile apps. [New] [9]			2 (0)	The SMEs were supportive and encouraging of the inclusion of a question concerning the provisioning of and/or promotion of wearable and other electronic activity trackers.
		Encourage active transportation to and from work? Answer “yes” if, for example, your worksite subsidizes public transportation; subsidizes a bike share program; provides secure bicycle storage, lockers and shower facilities for employees; allows for a flexible dress code; and/or organizes workplace challenges, employee recognition programs, or community events to increase active transportation. [New] [10]			3 (0)	This question was proposed based on existing evidence concerning the effectiveness of environmental supports and other subsidies for increasing physical activity. The question was supported by the SME panel, though there was discussion over potential overlap with original question 50.
Total Possible Points					22 (24)

Weight Management
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Provide free or subsidized body composition measurement, such as height and weight, Body Mass Index (BMI) scores, or other body fat assessments (beyond self-report) followed by directed feedback and clinical referral when appropriate?		Provide free or subsidized body composition measurement (beyond self-report) followed by directed feedback and clinical referral when appropriate? Answer “yes” if, for example, your worksite offers periodic height and weight measurement, body mass index (BMI) scores, or other body fat assessments (beyond HRAs), plus follow-up recommendations. This may be offered as part of an occasional health fair or routine care at an on-site clinic. [57] [1]			1 (2)	The root question was streamlined and simplified by moving examples into the subtext.
Provide brochures, videos, posters, pamphlets, newsletters, or other written or online information that address the risks of overweight or obesity? Answer “yes” if these health promotion materials address the risks of overweight or obesity as a single health topic or if the risks of overweight or obesity are included with other health topics.		Provide educational materials that address the health risks of overweight or obesity? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters that address the risks of overweight or obesity, either as a single health topic or along with other health topics. [58] [2]			1 (1)	The root question text was edited in alignment with questions in other modules.
Provide a series of educational seminars, workshops, or classes on weight management? Answer “yes” if these sessions address weight management as a single health topic or if weight management is included with other health topics. These sessions can be provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		Provide and promote interactive educational programming on weight management? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes that teach and promote weight management. These programs may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [59] [3]			3 (3)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies in and of themselves do not achieve results.
Provide free or subsidized one-on-one or group lifestyle counseling for employees who are overweight or obese? Answer “yes” if these programs are provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		Provide and promote free or subsidized lifestyle coaching/counseling or self-management programs that equip employees with skills and motivation to set and meet their personal weight management goals? Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [COMBINED 60 & 61] [4]			3 (3)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies in and of themselves do not achieve results.
Provide free or subsidized self-management programs for weight management? Answer “yes” if these programs are provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		<DELETE>			0 (3)	This question was merged with the previously existing question about counseling and other follow-up services (original question 60). A similar change was made across modules.
Total Possible Points					8 (12)

Nutrition
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Provide places to purchase food and beverages? Answer “yes” if, for example, your worksite provides vending machines, cafeterias, snack bars, or other purchase points. IF NO, PLEASE SKIP TO QUESTION 36.		Provide places to purchase food and beverages? Answer “yes” if, for example, your worksite provides vending machines, cafeterias, snack bars, or other purchase points. IF NO, PLEASE SKIP TO QUESTION 8 [29] [1]			0 (0)	Question remains unscored.
Have a written policy or formal communication that makes healthier food and beverage choices available in cafeterias or snack bars? Answer “yes” if, for example, the policy or formal communication makes vegetables, fruits, 100% fruit juices, whole grain items and trans fat-free or low-sodium snacks available in cafeterias or snack bars.		Have and promote a written policy that makes healthier food and beverage choices available in cafeterias or snack bars? Answer “yes” if, for example, your worksite has a policy or contract that makes vegetables, fruit, fish, whole grain items, nuts and legumes available in cafeterias and limits sugary beverages, unhealthy fats (saturated or trans fats), and highly-processed or high-sodium foods. This policy can be promoted to employees regularly through emails, newsletters, or signage in public places. [30] [2]			2 (1)	“And promote” was added across all modules to policy questions to emphasize that these policies are only effective when employees are aware and know how to access benefits. The phrase “formal communication” was removed based on SME feedback that policy and communications were very separate concepts. The word “contract” was added to the subtext based on SME suggestions that nutritional content can be influenced when enacting such agreements. This change was also enacted for the similar question about vending machine options. Definitions of “unhealthy fats” were added for enhanced education. The increase in the adjusted score from 1 to 2 points reflects an increase in evidence and impact ratings, based on both Truven/JHU-led recommendations and SME agreement.
31. Have a written policy or formal communication that makes healthier food and beverage choices available in vending machines? Answer “yes” if, for example, the policy or formal communication makes vegetables, fruits, 100% fruit juices, whole grain items and trans fat-free/low-sodium snacks available in vending machines.		Have and promote a written policy that makes healthier food and beverage choices available in vending machines or other vending outlets? Answer “yes” if, for example, your worksite has a policy or contract that makes nuts, whole grain items, trans fat-free/low-sodium snacks, vegetables, fruit, or unsweetened beverages available in vending machines. This policy can be promoted to employees regularly through e-mails, newsletters, or signage in public places. [31] [3]			1 (1)	“And promote” was added across all modules to policy questions to emphasize that these policies are only effective when employees are aware and know how to access benefits. The word “contract” was added to the subtext based on SME suggestions that nutritional content can be influenced when enacting such agreements. This change was also enacted for the similar question about cafeteria and snack bar options.
32. Make most (more than 50%) of the food and beverage choices available in vending machines, cafeterias, snack bars, or other purchase points be healthier food items? Answer “yes” if the healthy foods are items such as skim milk, 1% milk, water, unsweetened flavored water, diet drinks, 100% fruit juice, low-fat and low-sodium snacks, or fresh fruit. (See Dietary Guidelines for Americans, 2010 or GSA/HHS Health and Sustainability Guidelines for Federal Concessions and Vending Operations.)		Make most (more than 50%) of the food and beverage choices available in vending machines, cafeterias, snack bars, or other purchase points healthy food items? Answer “yes” if the healthy foods and beverages are items such as vegetables, fruit, unsweetened beverages, or low-sodium snacks. [32] [4]			3 (3)	The subtext was generalized to address SME concerns regarding the quickly changing nature of nutritional recommendations. In place of listing specific examples of nutritional guidelines in the subtext, the Resources section for the module now includes several recommended sources for nutritional information.
33. Provide nutritional information (beyond standard nutrition information on labels) on sodium, calories, trans fats, or saturated fats for foods and beverages sold in worksite cafeterias, snack bars, or other purchase points?		Provide visible nutritional information (beyond standard food labels) on sodium, calories, trans fats, or saturated fats for foods and beverages sold in vending machines, cafeterias, snack bars, or other purchase points? [33] [5]			3 (2)
34. Identify healthier food and beverage choices with signs or symbols?♥ Answer “yes” if, for example, your worksite puts a heart next to a healthy item near vending machines, cafeterias, snack bars, or other purchase points.		Identify healthier (or less healthy) food and beverage choices with signs or symbols? Answer “yes” if, for example, your worksite puts a heart () next to a healthy item or uses red-yellow-green color-coding to indicate the healthfulness of items in vending machines, cafeterias, snack bars, or other purchase points. [34] [6]			3 (3)	The question format was revised to be more inclusive of other labeling systems that are in use, in addition to ensuring that it is clear that employers can select “yes” if they discourage consumption of particular food items with signs or symbols.
35. Subsidize or provide discounts on healthier foods and beverages offered in vending machines, cafeterias, snack bars, or other purchase points?		Subsidize or provide discounts on healthy foods and beverages offered in vending machines, cafeterias, snack bars, or other purchase points? [35] [7]			3 (3)
36. Have a written policy or formal communication which makes healthier food and beverage choices available during meetings when food is served? Answer “yes” if, for example, the policy or formal communication makes vegetables, fruits, 100% fruit juices, whole grain items or trans fat-free/low-sodium snacks available during meetings.		Have and promote a written policy making healthy food and beverage choices available in break rooms, during meetings, conferences or company sponsored events when food is served? Answer “yes” if, for example, the policy makes vegetables, fruits, unsweetened beverages, whole grain items, or trans fat-free/low-sodium snacks available during meetings. This policy can be promoted to employees regularly through emails, newsletters, or signage in public places. [36] [8]			1 (1)	“And promote” was added across all modules to policy questions to emphasize that these policies are only effective when employees are aware and know how to access benefits. The root question text was expanded based on discussions with the SMEs that employers can facilitate healthy eating at all events and generally within the workplace.
37. Provide employees with food preparation and storage facilities? Answer “yes” if your worksite provides a microwave oven, sink, refrigerator and/or kitchen.		Provide employees with food preparation/storage facilities and a place to eat? Answer “yes” if, for example, your worksite provides a microwave oven, sink, refrigerator, and a place for employees to eat other than at their workstations. [37] [13]			1 (1)	The subtext was expanded to add the phrase “other than at their workstations” to emphasize best practices for improving employee nutrition.
38. Offer or promote an on-site or nearby farmers’ market where fresh fruits and vegetables are sold?		Offer or promote an on-site or nearby farmers’ market or other arrangement where fresh fruits and vegetables are sold? This may include coordinating Community Supported Agriculture (CSA) or vendors/venues that are or are not operated by farmers. [38] [9]			1 (1)	The root question was revised and subtext added to clarify employer opportunities to make fresh fruits and vegetables available.
39. Provide brochures, videos, posters, pamphlets, newsletters, or other written or online information that address the benefits of healthy eating? Answer “yes” if these health promotion materials address the benefits of healthy eating as a single health topic or if the benefits of healthy eating are included with other health topics.		Provide educational materials that address healthy eating? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters that teach and promote healthy eating, either as a single health topic or along with other health topics. [39] [10]			1 (1)	The root question text was edited in alignment with questions in other modules.
40. Provide a series of educational seminars, workshops, or classes on nutrition? Answer “yes” if these sessions address nutrition as a single health topic or if nutrition is included with other health topics. These sessions can be provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		Provide and promote interactive educational programming on nutrition? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes that teach and promote healthy eating. These sessions may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [40] [11]			2 (2)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies in and of themselves do not achieve results.
41. Provide free or subsidized self-management programs for healthy eating? Answer “yes” if these programs are provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans and programs, community groups, or other practitioners.		Provide and promote free or subsidized lifestyle coaching/counseling or self-management programs that equip employees with skills and motivation to set and meet their personal nutrition goals? Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [41] [12]			2 (2)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies in and of themselves do not achieve results.
		Promote and provide access for increased water consumption? Answer “yes” if, for example, your worksite uses promotional materials and improved access by increasing water in vending machines or installing water bottle filling stations or water fountains. [New] [14]			1 (1)	This new question was added based on the evidence that water consumption has broad-based health benefits. “And provide” was added to emphasize that policies in and of themselves do not achieve results unless the appropriate environmental supports are available to employees.
Total Possible Points					24 (21)

Heart Attack and Stroke
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Have posters or flyers in the common areas of your worksite (such as bulletin boards, kiosks, break rooms) that identify the signs and symptoms of a heart attack and also convey that heart attacks are to be treated as emergencies?		Provide educational materials that address signs, symptoms, and emergency response to heart attack? Answer “yes” if, for example, your worksite offers employees brochures, videos, or newsletters, or posts flyers in the common areas of your worksite that teach the signs and symptoms and appropriate response to heart attack. [94] [1]			2 (1)	Underlining was added to help the respondent distinguish between questions pertaining to stroke versus heart attack. The adjusted value was increased from 1 to 2 points based on SME recommendations.
Have posters or flyers in the common areas of your worksite (such as bulletin boards, kiosks, break rooms) that identify the signs and symptoms of a stroke and also convey that strokes are to be treated as emergencies?		Provide educational materials that address signs, symptoms, and emergency response to stroke? Answer “yes” if, for example, your worksite offers employees brochures, videos, or newsletters, or posts flyers in the common areas of your worksite that teach the signs and symptoms and appropriate response to stroke. [95] [2]			2 (1)	Underlining was added to help the respondent distinguish between questions pertaining to stroke versus heart attack. The adjusted value was increased from 1 to 2 points based on SME recommendations.
Provide any other information on the signs and symptoms of heart attack through emails, newsletters, management communications, Web sites, seminars or classes?		Provide and promote interactive educational programming that addresses signs, symptoms, and emergency response to heart attack? Answer “yes” if, for example, your worksite offers ”lunch and learns,” seminars, workshops, or classes that teach the signs and symptoms and appropriate response to heart attack. These programs may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [96] [3]			2 (1)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies and programs in and of themselves do not achieve results. Underlining was added to help the respondent distinguish between questions pertaining to stroke versus heart attack. The adjusted value was increased from 1 to 2 points based on SME recommendations.
Provide any other information on the signs and symptoms of stroke through e-mails, newsletters, management communications, Web sites, seminars or classes?		Provide and promote interactive educational programming that addresses signs, symptoms, and emergency response to stroke? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes that teach the signs and symptoms and appropriate response to stroke. These programs may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [97] [4]			1 (1)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies and programs in and of themselves do not achieve results. Underlining was added to help the respondent distinguish between questions pertaining to stroke versus heart attack. There was consensus among the SMEs that the effectiveness and impact of interactive education should be rated lower for stroke than for heart attack.
Have an emergency response plan that addresses acute heart attack and stroke events?		Have an emergency response plan that addresses acute heart attack and stroke events? [98] [5]			1 (2)	The adjusted value of the question decreased from 2 to 1 point after consensus that the evidence specific to the effectiveness of the plan in isolation was weak.
Have an emergency response team for medical emergencies?		Have an emergency response team for medical emergencies? [99] [6]			2 (2)
Offer access to a nationally-recognized training course on Cardiopulmonary Resuscitation (CPR) that includes training on Automated External Defibrillator (AED) usage?		Offer access to a nationally-recognized training course on Cardiopulmonary Resuscitation (CPR) that includes training on Automated External Defibrillator (AED) usage? [100] [7]			2 (3)
Have a policy that requires an adequate number of employees per floor, work unit, or shift, in accordance with pertinent state and federal laws, to be certified in CPR/AED?		Have and promote a written policy that requires an adequate number of employees per floor, work unit, or shift, in accordance with pertinent state and federal laws, to be certified in CPR/AED? This policy can be promoted to employees regularly through emails, newsletters, or signage in public places. [101] [8]			2 (2)	“And promote” was added across all modules to policy questions to emphasize that these policies are only effective when employees are aware and know how to access benefits.
Have one or more functioning AEDs in place? IF NO, PLEASE SKIP TO QUESTION 107.		Have one or more functioning AEDs in place? IF NO, PLEASE SKIP TO THE NEXT MODULE [102] [9]			1 (3)	Discussion with the SMEs resulted in a recommendation to reduce the adjusted value of the question from 3 to 1 point because the focus of this question was simply whether the AED is or is not in place, while the subsequent questions provide additional point opportunities if they exist in recommended quantities, training is provided, and general awareness of the devices is promoted.
Have an adequate number of AED units such that a person can be reached within 3–5 minutes of collapse?		Have an adequate number of AED units so that a person can be reached within 3-5 minutes of collapse? [103] [10]			2 (2)
Identify the location of AEDS with posters, signs, markers, or other forms of communication other than on the AED itself?		Identify the location of AEDs with posters, signs, markers, or other forms of communication other than on the AED itself? [104] [11]			1 (1)
Perform routine maintenance or testing on all AEDs?		Perform maintenance or testing on all AEDs in alignment with manufacturer recommendations? [105] [12]			1 (1)	The question root was expanded to provide more guidance on the schedule of such maintenance.
Provide information to your local community Emergency Medical Service providers so they are aware that your worksite has an AED in place for an emergency response?		<DELETE>			0 (1)	After discussion the SME panel recommended deletion of this question. It was suggested that this question was originally included because CPR training did not used to provide education about AEDs.
Total Possible Points					19 (21)

Prediabetes and Diabetes
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Provide free or subsidized pre-diabetes and diabetes risk factor assessment (beyond self-report) and feedback, followed by blood glucose screening and/or clinical referral when appropriate?		Provide free or subsidized prediabetes and diabetes health risk assessment (beyond self-report) and feedback, followed by blood screening (fasting glucose or A1c) and clinical referral when appropriate? [88] [1]			3 (3)
Provide brochures, videos, posters, pamphlets, newsletters, or other written or online information that address the risks of diabetes? Answer “yes” if these health promotion materials address the risks of diabetes as a single health topic or if the risks of diabetes are included with other health topics.		Provide educational materials on prediabetes and diabetes? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters that address prediabetes and diabetes, including topics such as diet modification, physical activity, foot exams, and eye exams, either as a single health topic or along with other health topics. [89] [2]			1 (1)	The root question text was edited in alignment with questions in other modules. The subtext was revised to provide more education to regarding potential topics.
Provide a series of educational seminars, workshops, or classes on preventing and controlling diabetes? Answer “yes” if these sessions address preventing and controlling diabetes as a single health topic or if preventing and controlling diabetes are included with other health topics. These sessions can be provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		Provide and promote interactive educational programming on preventing and controlling diabetes? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes that address prediabetes and diabetes control and prevention. These programs may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [90] [3]			3 (3)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies and programs in and of themselves do not achieve results.
Provide one-on-one or group lifestyle counseling and follow-up monitoring for employees who have abnormal blood glucose levels (pre-diabetes or diabetes)? Answer “yes” if these programs are provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		Provide and promote free or subsidized intensive lifestyle coaching/counseling and follow-up monitoring for employees with prediabetes or diabetes? Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [91] [4]			3 (3)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies and programs in and of themselves do not achieve results. While this question is combined in other modules with the provisioning of self-management options, the SMEs felt strongly that for diabetes specifically, these interventions were unique.
Provide free or subsidized self-management programs for diabetes control? Answer “yes” if these programs are provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		Provide and promote self-management programs for diabetes control? Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [92] [5]			3 (3)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies and programs in and of themselves do not achieve results. While this question is combined in other modules with the provisioning of counseling, the SMEs felt strongly that for diabetes specifically, these interventions were unique.
Provide health insurance coverage with no or low out-of-pocket costs for diabetes medications and supplies for diabetes management (glucose test strips, needles, monitoring kits)?		Provide health coverage with free or subsidized out-of-pocket costs for diabetes medications as well as supplies for diabetes management (e.g., glucose test strips, needles, monitoring kits)? [93] [6]			2 (2)
Total Possible Points					15 (15)

Depression
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Provide free or subsidized clinical screening for depression (beyond self-report) followed-by directed feedback and clinical referral when appropriate? Answer “yes” if these services are provided directly through your organization or indirectly through a health insurance plan.		Provide free or subsidized clinical assessment for depression by a provider followed by directed feedback and clinical referral when appropriate? Answer "yes" if these services are provided directly through your organization or indirectly through a health insurance plan. [68] [1]			3 (3)	The clause “beyond self-report” was removed since depression screening necessarily includes self-report.
Provide access to online or paper self-assessment depression screening tools?		Provide access to self-administered depression screening tools followed by directed feedback and clinical referral when appropriate? Answer “yes” if, for example, these services are provided through a health risk assessment (HRA), health insurance plan, and/or employee assistance program (EAP). [69] [2]			2 (2)	SMEs suggested that a reference to EAP should be included in this question. So the subtext was added to mirror Q2 in the Alcohol and Substance Abuse module.
Provide brochures, videos, posters, pamphlets, newsletters, or other written or online information that address depression? Answer “yes” if these health promotion materials address depression as a single health topic or if depression is included with other health topics.		Provide educational materials on preventing, detecting, and treating depression? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters that address depression, either as a single health topic or along with other health topics. [70] [3]			1 (2)	The text of this question is more specific than other module questions related to more passive forms of education based on SME recommendations that the tool should provide education that emphasizes the multi-faceted nature of depression and the varying steps that employers can take to improve employee well-being. The adjusted value of the question was decreased from 2 to 1 due to SME feedback that these more passive interventions alone have limited effectiveness.
Provide a series of educational seminars, workshops, or classes on preventing and treating depression? Answer “yes” if these sessions address depression as a single health topic or if depression is included with other health topics. These sessions can be provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		Provide and promote interactive educational programming on preventing, detecting, and treating depression? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes focused on reducing the risk factors for depression and reducing the stigma surrounding depression. These programs may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [71] [4]			2 (3)	“And promote” was added to the root of several questions across modules to emphasize that policies in and of themselves do not achieve results. The adjusted value of the question was decreased from 3 to 2 due to SME feedback that the impact rating for these interventions warranted only a 2.
Provide one-on-one or group lifestyle counseling for employees with depression? Answer “yes” if these programs are provided in-person or online; on- site or off-site; in group or individual settings; through vendors, on- site staff, health insurance plans and programs, community groups, or other practitioners.		Provide and promote free or subsidized lifestyle coaching/counseling or self-management programs that equip employees with skills and motivation to set and meet their personal goals for managing depression? Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [72] [5]			3 (3)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies in and of themselves do not achieve results.
Provide training for managers on depression in the workplace? Answer “yes” if, for example, your worksite provides managers with training on how to recognize depression, productivity or safety issues, and company or community resources for managing depression.		Provide training for managers that improves their ability to recognize depression and refer employees to company/community resources for managing depression? [73] [6]			2 (2)	Removed “productivity or safety issues” from the subtext to emphasize that the focus of the question is on depression rather than safety more broadly.
Provide health insurance coverage with no or low out-of­pocket costs for depression medications and mental health counseling?		Provide health insurance coverage with free or subsidized out-of-pocket costs for depression medications? [74] [7]			3 (3)
Total Possible Points					16 (18)

Stress Management
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Provide dedicated space that is quiet where employees can engage in relaxation activities, such as deep breathing exercises?		Provide dedicated space that is quiet where employees can engage in relaxation activities, such as deep breathing exercises? [62] [4]			1 (1)
Sponsor or organize social events throughout the year? Answer “yes” if, for example, your worksite sponsors or organizes team building events, company picnics, holiday parties, or employee sports teams.		Sponsor or organize social activities designed to improve engagement with others, and provide opportunities for interaction and social support? Answer “yes” if, for example, your worksite sponsors or organizes team building events, company picnics, holiday parties, or employee sports teams. [63] [5]			1 (1)	The root question was reworded based on SME suggestions to further emphasize creating environments that encourage and provide social support.
Provide stress management programs? Answer “yes” if these programs address stress management as a single health topic or if stress management is included with other health topics. Answer “yes” if these programs are provided in-person or online; on-site or off-site; in group or individual settings; through vendors, on-site staff, health insurance plans or programs, community groups, or other practitioners.		<DELETE>			0 (3)	Three new questions were added to the module that capture the varying aspects of “stress management programs”, including the passive and interactive educational components and counseling/self-management opportunities.
		Provide educational materials on stress management? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters that address aspects of stress management, including coping skills and relaxation techniques, either as a single health topic or along with other health topics. [ASPECTS OF 64] [1]			1(0)
		Provide and promote interactive educational programming on stress management? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes on topics such as assertiveness, coping, and relaxation techniques. Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [ASPECTS OF 64] [2]			2 (0)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies and programs in and of themselves do not achieve results.
		Provide and promote free or subsidized lifestyle coaching/counseling or self-management programs that equip employees with skills and motivation to set and meet their personal stress management goals? Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [ASPECTS OF 64] [3]			3(0)	The root question text was edited in alignment with questions in other modules, including the addition of “and promote” to emphasize that policies and programs in and of themselves do not achieve results.
Provide work-life balance/ life-skills programs? Answer “yes” if, for example, your worksite provides elder care, child care, referrals, tuition reimbursement, or other programs that are offered through vendors, on-site staff, or employee assistance programs.		<DELETE>			0 (3)	This question was moved to the Organizational Supports module after much discussion regarding the cross-cutting nature of work-life balance and life-skills programs.
Provide training for managers on identifying and reducing workplace stress-related issues? Answer “yes” if, for example, your worksite provides training on performance reviews, communication, personnel management, assertiveness, time management, or conflict resolution.		Provide training for managers that improves their ability to recognize and reduce workplace stress-related issues? Answer “yes” if, for example, your worksite provides training on performance reviews, communication, personnel management, assertiveness, time management, or conflict resolution. [66] [6]			3 (3)
Provide opportunities for employee participation in organizational decisions regarding workplace issues that affect job stress? Answer “yes” if, for example, your worksite provides opportunities for employees to participate in decisions about work processes and environment, work schedules, participative problem-solving, and management of work demands.		Provide opportunities for employee participation in organizational decisions regarding workplace issues that affect job stress? Answer “yes” if, for example, your worksite provides opportunities for employees to participate in decisions about work processes and environment, work schedules, participative problem-solving, and management of work demands. [67] [7]			3 (3)
Total Possible Points					14 (14)

Alcohol and Other Substance Use
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
		Have and promote a written policy banning alcohol and other substance use at the worksite? Answer “yes” if, for example, your worksite has a written policy that bans alcohol and other substance use at the worksite or while operating a motor vehicle, requires universal drug testing (in appropriate safety-sensitive industries), or indicates options offered for assistance and referral to behavioral health services. This policy can be communicated to employees regularly through emails, newsletters, or signage in public places. [1]			1 (0)
		Provide access to alcohol and other substance use screening followed by brief intervention and referral for treatment when appropriate? Answer “yes” if, for example, these services are provided through a health risk assessment (HRA), health insurance plan, and/or employee assistance program (EAP). [2]			3 (0)
		Provide educational materials that help workers understand the risks of alcohol and other substance use and guide them to receive help? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters that address alcohol and other substance use, either as a single health topic or along with other health topics. [3]			1 (0)
		Provide and promote interactive educational programming that integrates health promotion with substance use prevention? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes. These may address alcohol and other substance use either directly or indirectly through topics such as stress management, conflict resolution, managing multiple priorities, personal finance planning, and team-building. [4]			2 (0)
		Discourage or limit access to alcohol or use of company funds for alcohol at work-related events? [5]			1 (0)
		Provide a health plan with insurance benefits that include substance use disorder prevention and treatment? Answer “yes” if, for example, your worksite health plan offers coverage for medication-assisted treatment without prior authorization and lifetime limits, while preventing overuse of addictive substances such as opioid pain relievers (e.g., reimbursement for nonpharmacological treatments for pain, use of drug utilization review, and pharmacy lock-in). [6]			1 (0)
Total Possible Points					9 (0)

Sleep and Fatigue
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
		Have and promote a written policy related to the design of work schedules that aims to reduce employee fatigue? Answer “yes” if, for example, your worksite has a policy related to self-scheduling, limiting the number of consecutive days or hours allowed to be worked, or specifying a minimum time interval between shifts. [1]			2 (0)
		Provide access to a self-assessment of sleep health followed by directed feedback and clinical referral, when appropriate? [2]			2 (0)
		Provide educational materials that address sleep habits and treatment of common sleep disorders? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters that address topics such as recommended sleep schedules, recognizing the signs and symptoms of fatigue or daytime sleepiness, and appropriate use of caffeine. [3]			1 (0)
		Provide and promote interactive educational programming that addresses sleep habits and treatment of common sleep disorders? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes that teach and promote appropriate sleep habits. These programs may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [4]			2 (0)
		Provide training for managers to improve their understanding of the safety and health risks associated with poor sleep and their skills for organizing work to reduce the risk of employee fatigue? [5]			1 (0)
		Offer light-design solutions during shifts that are intended to reduce fatigue during working hours? [6]			1 (0)
		Allow employees to take short naps during the workday/shift in order to reduce fatigue and improve performance? Answer “yes” if, for example, the workplace has dedicated napping spaces (such as “sleep pods”) and offers break times that may be used for sleep. [7]			1 (0)
		Offer solutions to discourage and prevent drowsy driving? Answer “yes” if, for example, employees have access to a place to nap before driving home or reimbursement for the use of taxi services to avoid driving after a shift. [8]			1 (0)
Total Possible Points					11 (0)

Musculoskeletal Disorders
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
		Have and promote a written policy that requires regular evaluation of the design of work spaces and job requirements? Answer “yes” if, for example, the policy includes ergonomic assessments for office-based workers and is promoted to employees regularly through emails, newsletters, or signage in public places. [1]			1 (0)
		Conduct an ergonomic assessment of workstations, when appropriate, to reduce the risk of musculoskeletal disorders? [2]			1 (0)
		Make adjustments to job design, when appropriate, to reduce the risk of musculoskeletal disorders? Answer “yes” if, for example, your worksite has adjusted work routines and workloads, implemented job rotation, or mechanized tasks that pose increased risk. [3]			2 (0)
		Provide educational materials on musculoskeletal disorders? Answer “yes” if, for example, your worksite offers brochures, videos, posters, or newsletters that teach and promote strategies that minimize the incidence of musculoskeletal disorders such as ergonomic design, stretching, regular breaks, and weight management, either as a single health topic or along with other health topics. [4]			1 (0)
		Provide and promote interactive educational programming on musculoskeletal disorders? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes that teach strategies that minimize the risk of musculoskeletal disorders such as ergonomic design, stretching, regular breaks, and weight management. These programs may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [5]			1 (0)
		Provide training for managers that improves their ability to recognize potential risks for musculoskeletal disorders and refer employees to company/community resources? [6]			1 (0)
		Provide health insurance that includes appropriate access to therapies and treatment for musculoskeletal disorders? Answer “yes” if, for example, coverage options are aligned with best practices recommended by the Occupational Safety & Health Administration (OSHA), American College of Occupational & Environmental Medicine (ACOEM), or American College of Rheumatology. [7]			2 (0)
Total Possible Points					8 (0)

Occupational Health and Safety
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Include improving or maintaining job health and safety in the business objectives or organizational mission statement? Answer “yes” if any written vision, planning, or guideline documents include language about improving or maintaining worker health and safety.		<DELETE>			0 (1)	Questions 14 (from Organizational Supports) and 107 were determined to be closely overlapping and redundant, offering an opportunity for additional “points” without representing additional provisions or programs for improving employee health or safety. The revised/combined question is now in the “Leadership Commitment and Support” section of the Organizational Supports module.
Have a written injury and/or illness prevention program? Answer “yes” if there is a written policy, whether or not it is posted.		Have and promote a written policy on injury prevention and occupational health and safety? This policy could be promoted to employees regularly through emails, newsletters, or signage in public places. [108] [1]			2 (2)	“And promote” was added across all modules to policy questions to emphasize that these policies are only effective when employees are aware and know how to access benefits.
Employ or contract for an occupational health and safety professional? Answer “yes” if anyone is employed or contracted whose job includes improving health safety: example include occupational nurse, safety manager, environmental health manager, ergonomist, an insurance safety specialist who visits regularly.		<DELETE>			0 (3)	SME panel agreed with recommendation to remove the question, as the questions that follow presuppose that this role is exists.
Encourage reporting of injuries and near misses? Answer “yes” if there is written and/or verbal encouragement to report injuries, illnesses, or near misses.		Encourage employees to report uncomfortable, unsafe, or hazardous working conditions to a supervisor, occupational health and safety professional or another reporting channel? Answer “yes” if, for example, employees are directed to report workplace injuries, bullying, or sexual harassment using a designated hotline. [110] [3]			2 (3)	The root of the question was expanded to describe potential avenues for reporting issues with working conditions.
Provide opportunities for employee input on hazards and solutions? Answer “yes” if, for example, there were all-hands meetings, tool box meetings, surveys, or focus groups for discovering and solving job health and/or safety issues.		Provide opportunities for employee input on hazards and solutions, and implement these solutions when appropriate? Answer “yes” if, for example, there were all-hands meetings, surveys, or focus groups for discovering and solving job health and/or safety issues. [111] [2]			3 (3)	The root of the question was expanded to incorporate a requirement for intervention, given feedback that improvement can only be achieved when such information is appropriately leveraged.
Have a program to investigate the causes of injuries or illnesses? Answer “yes” if, for example, there were all-hands meetings, tool box meetings, surveys, or focus groups for discovering and solving job health and/or safety issues.		Carefully investigate the primary cause of any reported work-related illnesses or injuries and take specific actions to prevent similar incidents in the future? [112] [4]			3 (3)	Revision suggested by SMEs to improve clarity and specificity of action.
Provide informational materials about health and safety at work to employees in most departments? Answer “yes” if, for example, there are health and safety newsletters, fact sheets, posters, LED displays, emails, letters, broadcast messages, or other communications provided to employees.		Provide educational materials about health and safety at work? Answer “yes” if, for example, your worksite provides brochures, videos, posters, newsletters, or timely reminders for issues such as hand washing, taking breaks to reduce eye strain, or wearing personal protective equipment. [113] [5]			1 (1)
Provide all new workers formal, comprehensive training on how to avoid accidents or injury on the job?		Provide and promote interactive educational programming on how to avoid incidents or injury on the job? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes that address injury prevention. These sessions can be provided in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, or other practitioners. [114] [6]			2 (2)	The root of the question was expanded to emphasize that such education should be delivered routinely in order to maximize effectiveness and prevent incidents and injuries. “Accidents” was removed from the root question as the term is no longer suggested for use by the SMEs.
Coordinate programs for occupational health and safety with program for health promotion and wellness? Answer “yes” if, for example a new safety initiative also includes a wellness component such as attention to diet, physical activity, smoking, etc.).		<DELETE>			0 (2)	The question was moved to the Organizational Supports module, and reworded to emphasize the need for bi-directionality between health and safety programs.
Have the following policies or benefits for employees been in place?		<DELETE>			N/A	No longer relevant to the module (see below)
116A. Paid time off (PTO) for days or hours due to illness of employees or dependents (full-time, non-exempt employees). [Note: non-exempt employees are those who are eligible to receive overtime pay if they work more than 40 hours in a week. Typically they are hourly workers.]		<DELETE>			0 (1)	This question was moved to the “Programs, Policies, and Environmental Supports” subsection of the Organizational Supports module because time off was viewed more as a general support and/or benefit than as a part of the specific health and safety culture.
116B. Paid vacation time or personal days or hours to full-time, non­ exempt employees).		<DELETE>			0 (1)	This question was moved to the “Programs, Policies, and Environmental Supports” subsection of the Organizational Supports module because time off was viewed more as a general support and/or benefit than as a part of the specific health and safety culture.
		Have a process in place for measuring and, if necessary, improving worksite air quality? Answer “yes” if, for example, your worksite routinely tests heating, ventilation, and air conditioning (HVAC) systems, vacuums carpets, and controls moisture levels to prevent mold growth. [New] [7]			2 (0)	This new question was added to highlight specific examples of how safety measures have implications for health more generally.
		Make adjustments or provide resources where necessary to reduce the risk of eye injury or vision impairment? Answer “yes” if, for example, your worksite provides proper lighting to work areas, protective eyewear in hazardous environments (e.g., factories, construction sites) or ergonomic setup at work stations. [New] [8]			2 (0)	This new question was added to highlight specific examples of how safety measures have implications for health more generally.
		Proactively support employees returning to work after illness or injury? Answer “yes” if, for example, your organization provided temporary job modifications or phased return-to-work options. [New] [9]			1 (0)	This new question was added after
Total Possible Points					18 (22)

Vaccine-Preventable Diseases
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Provide health insurance coverage with no or low out-of-pocket costs for influenza (flu) vaccination?		Provide health insurance coverage with free or subsidized influenza (flu) vaccinations? [117] [1]			3 (3)	Edited to say “free or subsidized since this is more specific than “low cost”.
Provide health insurance coverage with no or low out-of­ pocket costs for vaccinations other than influenza (flu) (e.g., pneumococcal or Tdap vaccines)?		Provide health insurance coverage with free or subsidized vaccinations for illnesses other than influenza? Answer yes if, for example, your worksite provides coverage for pneumococcal; tetanus, diphtheria, and pertussis (Tdap); or Zoster (shingles) vaccines? [118] [4]			3 (3)	Edited to say “free or subsidized since this is more specific than “low cost”.
Conduct influenza (flu) vaccinations at your worksite? Answer “yes” if these offerings happen one or more times a year; are set up as either a temporary vaccine clinic run by an outside organization, internal occupational health staff or other arrangement. IF NO, PLEASE PROCEED TO QUESTION NUMBER 121.		<DELETE>			0 (3)	This question was deemed repetitive to the other questions in the module, in particular original question 120 which asks whether influenza vaccines are provide at the worksite with no or low costs.
Provide influenza (flu) vaccinations at your worksite with no or low out-of-pocket costs to employees? Answer “yes” if these offerings happen one or more times a year; are set up as either a temporary vaccine clinic run by an outside organization, internal occupational health staff or other arrangement.		Provide free or subsidized influenza vaccinations at your worksite? Answer “yes” if this is offered to employees on-site, through a temporary vaccine clinic run by an outside organization, internal occupational health staff, or other arrangement. [120] [2]			3 (3)	Edited to say “free or subsidized since this is more specific than “low cost”.
Provide vaccinations other than seasonal influenza (e.g. pneumococcal or Tdap) at your worksite with no or low out-of­ pocket costs to employees? Answer “yes” if these offerings happen one or more times a year; are set up as either a temporary vaccine clinic run by an outside organization, internal occupational health staff or other arrangement.		Provide free or subsidized vaccinations at your worksite for illnesses other than influenza? Answer “yes” if, for example, your worksite offers employees pneumococcal; tetanus, diphtheria, and pertussis (Tdap); or Zoster (shingles) vaccines through a temporary vaccine clinic run by an outside organization, internal occupational health staff, or other arrangement. [121] [5]			2 (3)	The Truven/JHU evidence review suggested decreasing the adjusted value of this question from 3 to 2 points. The SME panel concurred that the evidentiary base and impact rating for non-influenza vaccinations clinics is currently lower than that for influenza vaccination clinics. Edited to say “free or subsidized since this is more specific than “low cost”.
Promote influenza (flu) vaccinations through brochures, videos, posters, pamphlets, newsletters or other written or online information that address the benefits of influenza vaccinations? Answer “yes” if these health promotion materials address the risks and benefits of influenza vaccination as a single health topic or if the benefits of influenza vaccinations are included with other health topics.		Conduct a seasonal influenza vaccination campaign that includes educational materials or programming? Answer “yes” if, for example, your worksite offers brochures, videos, posters, newsletters, timely reminders, or sessions that address the benefits of flu vaccinations, either as a single health topic or along with other health topics. [122] [3]			1 (3)	The Truven/JHU evidence review suggested decreasing the adjusted value of this question from 3 to 1 point. The SME panel concurred that the evidentiary basis and impact of the educational materials specifically is less robust than for the actual onsite availability of influenza vaccines.
		Promote vaccinations other than influenza with educational materials or educational programming? Answer “yes” if, for example, your worksite offers brochures, videos, posters, newsletters, timely reminders, or sessions that provide information on adult vaccine requirements and benefits, either as a single health topic or along with other health topics. [NEW] [6]			1 (0)	This question was added after discussion with the SME panel that employers could similarly provide and promote educational materials about vaccines other than influenza.
Total Possible Points					13 (18)

Maternal Health and Lactation Support
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Have a written policy on breastfeeding for employees? Answer “yes” if the policy is included as a component of other employee policies or is a separate policy related to breastfeeding.		Have a well-communicated written policy on breastfeeding for employees? Answer “yes” if, for example, this policy is communicated at the time of hiring and/or at the time of maternity leave planning. [42] [1]			1 (1)
Provide a private space (other than a restroom) that may be used by an employee to express breast milk?		Provide a private space (other than a restroom) that may be used by employees to express breast milk? Answer “yes” if, for example, your worksite has a private space with an electrical outlet, comfortable chair, and sink. [43] [2]			2 (2)	Subtext was incorporated for this question to educate employers about best practices that make lactation spaces more accessible and utilized by employees.
Provide access to a breast pump at the worksite?		Provide access to a breast pump at the worksite? Answer “yes” if, for example, your worksite provides on-site access to a breast pump or offers insurance coverage that subsidizes the purchase a pump for personal use. [44] [4]			2 (2)	Subtext was added to clarify potential implementation options for employers.
Provide flexible paid or unpaid break times to allow mothers to pump breast milk?		Provide flexible break times to allow employees to pump breast milk? [45] [3]			1 (1)	SMEs considered the inclusion of “paid or unpaid” unnecessary. Ideally we would like to push employers to offer paid break times, but it may be best to remain silent on this issue.
Provide free or subsidized breastfeeding support groups or educational classes? Answer “yes” if these sessions address breastfeeding as a single health topic or if breastfeeding is included with other health topics. These sessions can be provided in-person or online; onsite or offsite; in group or individual settings; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners.		Provide and promote maternal health and breastfeeding support groups, educational classes, or consultations? Answer “yes” if these programs are provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [46] [5]			3 (3)	“And promote” was added to the root of several questions across modules to emphasize that policies in and of themselves do not achieve results.
Offer paid maternity leave, separate from any accrued sick leave, annual leave, or vacation time?		Offer paid parental leave, separate from any accrued sick leave, annual leave, or vacation time? [47] [6]			3 (3)	Changed “maternal” to “parental” to acknowledge the positive benefits of leave for all parents, including those who are adopting.
		Offer health insurance coverage with no or low out-of-pocket costs for pre- and postnatal care? [New] [7]			3 (0)	This question was suggested after review of all modules, and added in order to increase alignment with the rest of the tool. Literature identified by the SMEs and the Truven/JHU team led to a recommendation of the highest rating.
Total Possible Points					15 (12)

Cancer
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
		Offer free or subsidized cancer screenings on-site? Answer “yes” if, for example, your worksite offered cancer screenings (e.g., stool test kits) as part of a health campaign or as part of routine care at an on-site clinic. [1]			2 (0)
		Provide educational materials that address skin, breast, cervical, or colorectal cancer prevention? Answer “yes” if, for example, your worksite offers brochures, videos, posters, reminders, or newsletters that promote sun protection, evidence-based vaccinations, or evidence-based cancer screenings, either as a single health topic or along with other health topics. [2]			2 (0)
		Provide and promote interactive educational programming on cancer prevention? Answer “yes” if, for example, your worksite offers “lunch and learns,” seminars, workshops, or classes that address prevention, early identification, and survivorship. These sessions may be provided in group or individual settings; in-person or virtually (online, telephonically, mobile app); on or off site; through vendors, on-site staff, health insurance plans/programs, community groups, or other practitioners. [3]			2 (0)
		Monitor and take action to reduce employee exposure to known carcinogens within the workplace? Answer “yes” if, for example, your worksite takes action to limit exposures to radon, asbestos, and other carcinogens that may exist at the worksite, and uses alternative materials (i.e., “green chemistry”) where ever possible. [4]			1 (0)
		Provide health insurance coverage with free or subsidized evidence-based cancer screenings and vaccinations? Answer “yes” if, for example, your insurance covers the cost of breast, cervical, and colorectal cancer screening, and HPV and Hepatitis B vaccines. [5]			2 (0)
		Have and promote a written policy that includes measures to reduce sun exposure for outdoor workers? Answer yes if, for example, the policy encourages rotation of workers in ultra violet (UV) intense positions, scheduling of tasks to avoid high-exposure periods, and the use of sun protective clothing, hats, and sunscreen. This policy could be promoted to employees regularly through e-mails, newsletters, or signage in public places. [6]			1 (0)
		Provide employees working outdoors with supports for sun protection, such as shade, hats, or sunscreen? [7]			1 (0)
Total Possible Points					11 (0)

Community Resources
Question Text in the 2014 Health ScoreCard		Proposed Revised Text for the Updated Health ScoreCard			New (Old) Score	Notes / Justification
Provide employees with health related information, programs, or resources from any of the following organizations (not including your own organization)? Respond “yes” or “no” to all questions. Answer “yes” if health information, programs, or resources are provided in-person or online; on-site or off-site; or in group or individual settings.		Provide employees with health related information, programs, or resources from any of the following organizations (not including your own organization)? Respond “yes” or “no” to all questions. Answer “yes” if health information, programs, or resources are provided in-person or online; on-site or off-site; or in group or individual settings. [123] [1]			N/A
123A. State/local public health agency		A. Federal, State, or local public health agencies (e.g., Centers for Disease Control and Prevention)			N/A
123B. Health insurance plan		B. Health insurance plan, broker, or workers compensation provider			N/A
123C.Health management program and/or wellness program provider/vendor		C. Health management program and/or wellness program provider/vendor			N/A
123D. Workers compensation provider		<DELETE>			N/A
123E. Health-related organizations (such as the American Heart Association, American Cancer Society, etc).		D. Health-related organizations (e.g., American Heart Association, American Cancer Society)			N/A
123F. Health insurance broker		<DELETE>			N/A
123G. Hospital		E. Healthcare professionals (e.g., hospitals, providers, pharmacists, nutritionists)			N/A
123H. YMCA		F. Faith-based and/or religious-affiliated organizations (e.g., YMCA)			N/A
123I. Community Organization or Business Group (Wellness Council, Chamber of Commerce or other business group)		G. Business Groups or Councils (e.g., Wellness Council, Chamber of Commerce)			N/A
123J. Other: Respond “yes” if you work with an organization not listed above such as an Employee Assistance Program, Food Services, etc. to provide health information, programs, or resources to employees.		H. Other: ______________________________________ Respond “yes” if, for example, you work with an organization not listed above such as an Employee Assistance Program, Food Services vendor, Foundation, etc. to provide health information, programs, or resources to employees.			N/A
Receive consultation, guidance, advise, training, and/or direction from any of the following organizations related to the design and delivery of a worksite wellness program? Respond “yes” or “no” to all questions.		Receive consultation, guidance, advice, training, and/or direction from any of the following organizations related to the design and delivery of a worksite wellness program? Respond “yes” or “no” to all questions. [124] [2]			N/A
123A. State/local public health agency		A. Federal, State, or local public health agencies (e.g., Centers for Disease Control and Prevention)			N/A
123B. Health insurance plan		B. Health insurance plan, broker, or workers compensation provider			N/A
123C.Health management program and/or wellness program provider/vendor		C. Health management program and/or wellness program provider/vendor			N/A
123D. Workers compensation provider		<DELETE>			N/A
123E. Health-related organizations (such as the American Heart Association, American Cancer Society, etc).		D. Health-related organizations (e.g., American Heart Association, American Cancer Society)			N/A
123F. Health insurance broker		<DELETE>			N/A
123G. Hospital		E. Healthcare professionals (e.g., hospitals, providers, pharmacists, nutritionists)			N/A
123H. YMCA		F. Faith-based and/or religious-affiliated organizations (e.g., YMCA)			N/A
123I. Community Organization or Business Group (Wellness Council, Chamber of Commerce or other business group)		G. Business Groups or Councils (e.g., Wellness Council, Chamber of Commerce)			N/A
123J. Other: Respond “yes” if you work with an organization not listed above such as an Employee Assistance Program, Food Services, etc. to provide health information, programs, or resources to employees.		H. Other: ______________________________________ Respond “yes” if, for example, you work with an organization not listed above such as an Employee Assistance Program, Food Services vendor, Foundation, etc. to provide health information, programs, or resources to employees.			N/A
Participate in any Community Coalitions focused on health or business and community partnerships?		Participate in any Community Coalitions focused on or targeting health, including through business and community partnerships? [125] [3]			N/A
Total Possible Points					N/A

20

Comparison Table 6-23/17