Healthy Androscoggin

Award Categories and Levels

Support a Tobacco-Free Environment

Good!

1. Written Policy meets the Workplace Smoking Act of 1985 - Use of cigarettes, pipes, cigars is prohibited within 20 feet of all company owned/leased buildings and vehicles; and
2. Promote tobacco-free lifestyles by providing employees with self-help materials or referral information on tobacco treatment; and
3. Smoke free area signs are posted.

Better!

1. Meets above standards and
2. Written policy provides for a tobacco-free building and no tobacco use within 50 feet of all entrances, air intake and walkways. Tobacco use includes any tobacco product - including cigarettes, pipes, cigars, chew, snuff, and spit; and
3. Written policy provides some level of coverage on a one time basis for cessation services through Health Insurance coverage or employer reimbursement - i.e.: medications, cessation classes, etc.

Best!

1. Meets above standards and
2. Written policy provides for a tobacco-free property; and
3. Written policy includes provisions for enforcement and communicating the policy to all employees on an annual basis; and
4. Written policy provides on-going full coverage for cessation services through Health Insurance coverage or employer reimbursement - i.e.: medications, cessation classes, etc.- either on or off-site.

Encourage Physical Activity

Good!

1. Promote exercise and recreational activities to employees.

Better!

1. Meets above standards and
2. Provide incentives for engaging in exercise and recreational activities, and/or provide discounts/offer reimbursements for participation in fitness programs.

Best!

1. Meets above standards and
2. Provide on-site programming that support exercise and recreational activities.

Promote Healthy Eating

Good!

1. Offer healthy alternatives in vending machines, cafeterias or company meetings. Promote nutrition and weight management programs.

Better!

1. Meets above standards and
2. Provide incentives for participating in nutrition or weight management programs

Best!

1. Meets above standards and
2. Have a written policy in place that supports healthy food options
3. Provides on-site programming and incentives to support healthy eating and /or weight management and nutrition programs.

		* Indicates a required field
	Award Categories: Select the Award level you are applying for (See qualifications above).
	Support a Tobacco-Free Environment
		Good! Better! Best!
	Encourage Physical Activity
		Good! Better! Best!
	Promote Health Eating
		Good! Better! Best!
	Bonus Categories (Check all that apply)
	Written Breastfeeding Policy
	Promotion of Health Screenings (ie: cholestrol, mammograms, prostate, etc.)
	Description of Program(s)
	Dates of Program(s)
	Employee Assistance Program(s)
	Drug Free Workplace Policy
	Healthy Eating Written Policy encourages the use of local foods when appropriate and available.
	Please list all your Program activities and mail or fax your written policies to Healthy Androscoggin.
	Contact Information
*	Company / Organization Name
*	Number of Employees
*	Number of Locations
*	Counties for all ME locations
*	Contact Name
	Title
	Address
*	City
*	State
	Zip-code	nnnnn-nnnn
	Phone Number	(nnn)nnn-nnnn xnnnn
	Fax number	(nnn)nnn-nnnn
*	Email Address	(Valid Email Required)
	Re-enter Email
	Request Type (Check all that apply)
	I am applying for at least one category and level of award
	I will be sending our tobacco-free policy
	I would like assistance qualifying for an award
	Please call me - I would like more information
	Yes, I am willing to share my experience(s)
	Upload Policy and Program Files
	With your application, please upload your applicable policies and program information below
	You can upload up to 5 policy files for inclusion in your registration. Files must be one of the following types:
	PDF - Adobe PDF TXT - Plain Text DOC - MS Word Document DOCX - New MS Word Document RTF - Rich Text File
	If you have more than 5 files or any are larger than 8Mb, please email them to workhealthy@healthyandroscoggin.org
	Upload File 1
	Upload File 2
	Upload File 3
	Upload File 4
	Upload File 5

Please mail, email, or fax your written policies to:

Healthy Androscoggin

300 Main Street

Lewiston, ME 04240

workhealthy@healthyandroscoggin.org

Fax: (207) 795-5992

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