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pdfInformed Consent Block
Form Approved
OMB No. 0920-XXXX
Exp. Date: XX/XX/XXXX
CDC Worksite Health Scorecard
Public reporting of this collection of information is estimated to average 75
minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to
CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74,
Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).
The CDC Worksite Health ScoreCard is a tool designed to help employers
assess whether they have implemented evidence-based health promotion
interventions or strategies in their worksites to promote the health and wellbeing of employees.
On average, it will take you 75 minutes to complete the survey. You may need
to consult with another person to provide the most accurate and complete
information on your workplace health programs, policies, and practices.
Examples of people to consult with include human resource managers, health
benefit managers, health education staff, occupational nurses, medical
directors, wellness directors, or others responsible for worksite health
promotion in an organization.
Completing the survey is voluntary. No names will ever be reported.
If you have any questions, you can contact Jason Lang at the Centers for
Disease Control and Prevention. His phone number is 770-488-5597 and his
email is [email protected].
Instructions
Answer “yes” or “no” for each question on the tool.
All questions should be answered consistently with your worksite
practices and programs that are current or that have been in place within
the last 12 months.
There are 18 sections to the tool; you may complete each section in
separate sittings and in any order. Individual scores can be tallied for
each section and combined for an overall score once all sections are
completed.
We recommend that you form a small team, representing different
organizational units to complete this survey together. A team-based
approach will allow for more accurate responses, increase ownership and
involvement amongst the team, and decrease effort for any single team
member. Since a strong knowledge of your organization and its health
promotion program(s) is recommended to accurately complete the tool,
strive to pick team members who occupy the following positions:
o Members of a worksite health promotion committee
o Human resource managers
o Health benefits managers
o Health education staff
o Occupational nurses
o Medical directors
o Wellness directors
o Health promotion coordinators
o Building facilities managers
Scan each section before attempting to respond. Answers to most
questions are readily available following a review of organizational health
policies (e.g., a policy handbook), benefit plan designs, interviews with
key stakeholders, and direct observation. In some cases, answers may
not be immediately obvious to the person assigned to complete the
section. If you do not know the answer to the question, leave the box
empty, and then engage others at the worksite to help you answer it.
Some questions ask you to describe your health insurance plan. If your
organization offers more than one health insurance option, refer to the
health insurance plan with the highest enrollment. Throughout the survey,
questions refer to “health promotion” at your worksite.
Background and Community Engagement Information
Background and Community Engagement Information
Respondent name:
Respondent title:
Worksite address:
Telephone:
E-mail Address:
Employee Characteristics
If exact figures are not available, please provide your best estimates
Number of employees at your organization (entire enterprise)
1 - 49
50 - 99
100 - 249
250 - 749
≥ 750
Do you have multiple worksites/locations?
Yes
No
How many employees are at the location for which you are completing this
survey?
1 - 49
50 - 99
100 - 249
250 - 749
≥ 750
Sex
0
% Male
0
% Female
Age groups
% < 18 years of age
0
% 18 - 34 years of age
0
% 35 - 44 years of age
0
% 45 - 64 years of age
0
% ≥ 65 years of age
0
Total
0
Average age
Racial/ethnic group
% Non-Hispanic White
0
%
% Non-Hispanic Black/African American
0
%
% Hispanic/Latino
0
%
% Asian/Asian American
0
%
% American Indian/Alaska Native
0
%
% Native Hawaiian/Pacific Islander
0
%
% Other
0
%
Total
0
%
Work status
0
% Full-time
0
% Part-time
0
% Temporary
Job type
0
% Salaried
0
% Hourly
Education level
% Less than high school diploma
0
%
% High school graduate/GED
0
%
% Some college/technical school
0
%
% College graduate
0
%
% Post-graduate/advanced degree
0
%
Total
0
%
Organization and Program Background
Your organization's business type
For-profit
Non-profit/government
Non-profit/other
Your organization's industry type
Agriculture, Forestry, Fishing & Hunting
Mining, Quarrying, & Oil/Gas Extraction
Retail/Wholesale Trade
Accommodation & Food Services
Professional, Scientific & Technical Services
Transportation, Warehousing & Utilities
Health Care & Social Assistance
Real Estate & Rental & Leasing
Finance and Insurance
Management of Companies
Information
Construction
Educational Services
Manufacturing
Administrative & Support & Waste Management & Remediation Services
Arts, Entertainment & Recreation
Other Services (except Public Administration):
Public Administration
Health insurance coverage provided to employees?
Yes
No
Elements of worksite health promotion programs offered at your organization
(Check all that apply)
Health education (e.g., skills development and behavior change classes; awareness
building brochures, posters)
Links to related employee services (e.g., referral to employee assistance programs
[EAPs])
Supportive physical and social environment for health improvement (e.g., tobaccofree policies, subsidized gym memberships)
Integration of health promotion into your organization’s culture (e.g., health
promotion being part of business’ mission statement)
Employee screenings with adequate treatment and follow up (e.g., Health Risk
Assessments (HRAs) and biometric screenings)
Community Engagement
Does your worksite provide employees with health related information,
programs, or resources from any of the following organizations (Check all that
apply)
Federal, state, or local public health agencies (e.g., Centers for Disease Control and
Prevention)
Health insurance plan, broker, or workers’ compensation provider
Health management program and/or wellness program provider/vendor
Health-related organizations (e.g., American Heart Association, American Cancer
Society)
Healthcare professionals (e.g., hospitals, providers, pharmacists, nutritionists)
Faith-based and/or religious-affiliated organizations (e.g., YMCA)
Business groups or councils (e.g., Wellness Council, Chamber of Commerce)
Other
Check this box 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.
Does your worksite 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? (Check all that apply)
Federal, state, or local public health agencies (e.g., Centers for Disease Control and
Prevention)
Health insurance plan, broker, or workers compensation provider
Health management program and/or wellness program provider/vendor
Health-related organizations (e.g., American Heart Association, American Cancer
Society)
Healthcare professionals (e.g., hospitals, providers, pharmacists, nutritionists)
Faith-based and/or religious-affiliated organizations (e.g., YMCA)
Business groups or councils (e.g., Wellness Council, Chamber of Commerce)
Other
Check this box 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.
Does your worksite participate in any Community Coalitions focused on or
targeting health, including through business and community partnerships?
Yes
No
Organizational Supports
Organizational Supports
During the past 12 months, did your worksite:
Yes No
Leadership Commitment and Support
1. 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.
2. Include references to improving or maintaining employee health and
safety in the business objectives, core values, or organizational mission
statement?
3. 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.
4. Have an annual budget or receive dedicated funding for health promotion
programs?
5. 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).
Yes No
6. 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 off site and has
responsibility for health promotion as part of his or her job description or
performance expectations.
Measurement and Evaluation
7. 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.
8. 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.
9. 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.
Strategic Communications
10. 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."
11. 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?
Participation and Engagement
12. Have a champion or network of champions who actively promote health
promotion programs?
13. 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.
14. 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.
Yes No
15. Support employee volunteerism?
Answer “yes” if, for example, your organization supports participation in
community events, such as corporate walks or school-based efforts.
16. 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.
17. 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.
Programs, Policies, and Environmental Supports
18. 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.
19. 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.
20. 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.
21. 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.
22. 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.
23. 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.
24. 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.
Yes No
25. 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.
Tobacco Use
Tobacco Use
During the past 12 months, did your worksite:
Yes No
1. 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.
2. 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.
3. 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.
4. 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.
5. Prohibit the sale of tobacco products on company property?
Yes No
6. 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.
7. 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).
8. 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.
High Blood Pressure
High Blood Pressure
During the past 12 months, did your worksite:
Yes No
1. Provide free or subsidized blood pressure screening (beyond self-report)
followed by directed feedback and clinical referral when appropriate?
2. 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.
3. 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/prehypertension. 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.
Yes No
4. 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.
5. Make blood pressure monitoring devices available with instructions for
employees to conduct their own self assessments?
6. Provide health insurance coverage with free or subsidized out-of-pocket
costs for blood pressure control medications?
High Cholesterol
High Cholesterol
During the past 12 months, did your worksite:
Yes No
1. Provide free or subsidized cholesterol screening (beyond self-report)
followed by directed feedback and clinical referral when appropriate?
2. 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.
3. 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.
Yes No
4. 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.
5. Provide health insurance coverage with free or subsidized out-of-pocket
costs for cholesterol or lipid control medications?
Physical Activity
Physical Activity
During the past 12 months, did your worksite:
Yes No
1. 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.
2. 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.
3. 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.
4. Provide an exercise facility on site?
5. Subsidize or discount the cost of on or off site exercise facilities?
Yes No
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
Weight Management
Weight Management
During the past 12 months, did your worksite:
Yes No
1. Provide free or subsidized body composition measurement (beyond selfreport) 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.
Yes No
2. 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.
3. 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.
4. 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.
Nutrition
Nutrition
During the past 12 months, did your worksite:
Yes No
1. 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
2. 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.
Yes No
3. 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 emails, newsletters, or
signage in public places.
4. 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.
5. Provide visible nutritional information (beyond standard food labels) on
sodium, calories, trans fats, or saturated fats for foods and beverages sold
in worksite cafeterias, snack bars, or other purchase points?
6. 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.
7. Subsidize or provide discounts on healthy foods and beverages offered in
vending machines, cafeterias, snack bars, or other purchase points?
8. 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.
9. 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.
10. 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.
11. 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 can be provided in-person or virtually (online, telephonically,
mobile app); on or off site; in group or individual settings; through vendors,
on-site staff, health insurance plans/programs, community groups, or other
practitioners.
Yes No
12. 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; in
group or individual settings; through vendors, on-site staff, health insurance
plans/programs, community groups, or other practitioners.
13. 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.
14. Promote and provide access for increased water consumption?
Answer “yes” if, for example, your worksite used promotional materials and
improved access by increasing water in vending machines or installing water
bottle filling stations or water fountains.
Heart Attack and Stroke
Heart Attack and Stroke
During the past 12 months, did your worksite:
Yes No
1. 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.
2. 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.
Yes No
3. 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.
4. 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.
5. Have an emergency response plan that addresses acute heart attack and
stroke events?
6. Have an emergency response team for medical emergencies?
7. Offer access to a nationally-recognized training course on
Cardiopulmonary Resuscitation (CPR) that includes training on Automated
External Defibrillator (AED) usage?
8. 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.
9. Have one or more functioning AEDs in place?
IF NO, PLEASE SKIP TO THE NEXT MODULE
10. Have an adequate number of AED units so that a person can be reached
within 3-5 minutes of collapse?
11. Identify the location of AEDs with posters, signs, markers, or other forms
of communication other than on the AED itself?
12. Perform maintenance or testing on all AEDs in alignment with
manufacturer recommendations?
Prediabetes and Diabetes
Prediabetes and Diabetes
During the past 12 months, did your worksite:
Yes No
1. 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?
2. 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.
3. 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.
4. 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.
5. 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.
6. 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)?
Depression
Depression
During the past 12 months, did your worksite:
Yes No
1. 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.
2. 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).
3. 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.
4. 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.
5. 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.
6. Provide training for managers that improves their ability to recognize
depression and refer employees to company/community resources for
managing depression?
7. Provide health insurance coverage with free or subsidized out-of-pocket
costs for depression medications?
Stress Management
Stress Management
During the past 12 months, did your worksite:
Yes No
1. 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.
2. 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.
3. 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.
4. Provide dedicated space that is quiet where employees can engage in
relaxation activities, such as deep breathing exercises?
5. 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.
6. 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.
7. 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.
Alcohol and Other Substance Use
Alcohol and Other Substance Use
During the past 12 months, did your worksite:
Yes No
1. 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.
2. 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).
3. 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.
4. Provide and promote interactive educational programming that integrates
health promotion with substance use prevention?
Answer “yes” if, for example, your worksite offers health promotion “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.
5. Discourage or limit access to alcohol or use of company funds for alcohol
at work-related events?
6. 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).
Sleep and Fatigue
Sleep and Fatigue
During the past 12 months, did your worksite:
Yes No
1. Have a 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 selfscheduling, limiting the number of consecutive days or hours allowed to be
worked, or specifying a minimum time interval between shifts.
2. Provide access to a self-assessment of sleep health followed by directed
feedback and clinical referral, when appropriate?
3. 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.
4. Provide and promote interactive educational programming that addresses
sleep habits and treatment of common sleep disorders?
Answer “yes” if, for example, your worksite offers seminars, workshops, or
classes that teach and promote appropriate sleep habits. These sessions can
be provided in-person or online; on or off site; in group or individual settings;
through vendors, on-site staff, health insurance plans or programs,
community groups, or other practitioners.
5. 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?
6. Offer light-design solutions during shifts that are intended to reduce
fatigue during working hours?
7. 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.
8. 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.
Musculoskeletal Disorders
Musculoskeletal Disorders
During the past 12 months, did your worksite:
Yes No
1. 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 of
workstations, workloads, or repetitive tasks. This may be promoted to
employees regularly through emails, newsletters, or signage in public places.
2. Conduct an ergonomic assessment of workstations, when appropriate, to
reduce the risk of musculoskeletal disorders?
3. 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.
4. 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.
5. 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.
6. Provide training for managers that improves their ability to recognize
potential risks for musculoskeletal disorders and refer employees to
company/community resources?
7. 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.
Occupational Health and Safety
Occupational Health and Safety
During the past 12 months, did your worksite:
Yes No
1. Have and promote a written policy on injury prevention and occupational
health and safety?
This policy can be promoted to employees regularly through emails,
newsletters, or signage in public places.
2. 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.
3. Encourage employees to report uncomfortable, unsafe, or hazardous
working conditions to a supervisor, occupational health and safety
professional or through another reporting channel?
Answer “yes” if, for example, employees are directed to report workplace
injuries, bullying, or sexual harassment using a designated hotline.
4. Carefully investigate the primary cause of any reported work-related
illnesses or injuries and take specific actions to prevent similar events in the
future?
5. 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.
6. Provide and promote interactive educational programming on how to
avoid accidents 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.
7. 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.
8. 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.
Yes No
9. 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.
Vaccine-Preventable Diseases
Vaccine-Preventable Diseases
During the past 12 months, did your worksite:
Yes No
1. Provide health insurance coverage with free or subsidized influenza (flu)
vaccinations?
2. 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.
3. 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
4. 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.
5. 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.
6. 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.
Maternal Health and Lactation Support
Maternal Health and Lactation Support
During the past 12 months, did your worksite:
Yes No
1. 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.
2. 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.
3. Provide flexible break times to allow employees to pump breast milk?
4. 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 of a
pump for personal use.
5. Provide and promote maternal health and breastfeeding support groups,
educational classes, or consultations?
Answer “yes” if these programs are provided in-person or virtually (online,
telephonically, mobile app); on or off site; through vendors, peer and/or
professional consultants, on-site staff, or health insurance plans/programs.
6. Offer paid parental leave, separate from any accrued sick leave, annual
leave, or vacation time?
7. Offer health insurance coverage with no or low out of pocket costs for
pre- and postnatal care?
Cancer
Cancer
During the past 12 months, did your worksite:
Yes No
1. Offer free or subsidized cancer screenings on-site?
Yes No
Answer “yes” if, for example, your worksite offered cancer screenings (e.g.,
stool test kits, mobile mammography vans, or skin cancer screenings) as part
of a health campaign or as part of routine care at an on-site clinic.
2. 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.
3. 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 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. 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.
5. Provide health insurance coverage with free or subsidized evidencebased 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.
6. 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 can be promoted to employees regularly through emails, newsletters,
or signage in public places.
7. Provide employees working outdoors with supports for sun protection,
such as shade, hats, or sunscreen?
End of Survey/Scores
End of Survey
Thank you for completing the CDC Worksite Health ScoreCard. Your score is
reflected in the table below.
Topic
Organizational
Your
Maximum
Score
Score
${gr://SC_3IDTtnvv2osnwNv/Score}
44
Tobacco Use
${gr://SC_dnFNzx1J0lctHcV/Score}
18
High Blood
Pressure
${gr://SC_0PrJR1T4O5ASYtv/Score}
16
${gr://SC_8eQccAy1mvmT0bj/Score}
13
${gr://SC_bHhk0nPx49XNXcF/Score}
22
${gr://SC_0d0wG53Fd1EaVbD/Score}
8
${gr://SC_2n2hMVrsR3UGM73/Score}
24
${gr://SC_9WExkCdiNpUk9KZ/Score}
19
${gr://SC_3ObXh6qPXFQFSzr/Score}
15
${gr://SC_eWFokBeTIJqqvOZ/Score}
16
${gr://SC_cFIHYeyvk76GaQl/Score}
14
${gr://SC_2mCeDfxbYgeBBUF/Score}
9
Sleep & Fatigue ${gr://SC_6nWm9ceyza1UnXf/Score}
11
Supports
High
Cholesterol
Physical
Activity
Weight
Management
Nutrition
Heart Attack &
Stroke
Prediabetes &
Diabetes
Depression
Stress
Management
Alcohol & Other
Substance Use
Musculoskeletal
Disorders
Occupational
Health & Safety
${gr://SC_erlTug17pnkiS0t/Score}
8
${gr://SC_80OEOwsotXqWgPX/Score}
18
${gr://SC_8zVddSkKyAOZ5Gd/Score}
13
VaccinePreventable
Diseases
Topic
Your
Maximum
Score
Score
Maternal Health
& Lactation
${gr://SC_805IxORC5neOJBH/Score}
15
Cancer
${gr://SC_5pvFwTEuCgaom7r/Score}
11
Total
${gr://SC_cM7KT4PBlCp7dVH/Score}
294
Support
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| File Type | application/pdf |
| File Title | HSC_6_23_2017.pdf |
| File Modified | 2017-06-26 |
| File Created | 2017-06-23 |