Work Healthy Application
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Work Tobacco-Free
The Merit Award
Written Policy meets the Workplace Smoking Act of 1985 – Use of cigarettes, pipes, cigars is prohibited except in designated areas that are separately vented and also prohibited in employer vehicles; and
Promote tobacco-free lifestyles by providing employees with self-help materials or referral information on quitting tobacco use; and
Signs are posted that state the tobacco policy.
The Quality Award
Meets Merit Award; and
Written policy provides for a tobacco-free building and no tobacco use within 25 feet of all entrances, air intake and walkways. Tobacco use includes
any
tobacco product – including cigarettes, pipes, cigars, chew, snuff, and spit; and
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.
The Excellence Award
Meets Quality Award; and
Written policy provides for a tobacco-free property; and
Written policy includes provisions for enforcement and communicating the policy to all employees on an annual basis; and
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
The Merit Award
Promote exercise and recreational activities to employees..
The Quality Award
Meets Merit Award; and
Written policy in place that supports exercise and recreational activities; and
Provide incentives for engaging in exercise and recreational activities, and/or provide discounts/offer reimbursements for participation in fitness programs.
The Excellence Award
Meets Quality Award; and
Provide on-site programming that support exercise and recreational activities.
Promote Healthy Eating
The Merit Award
Offer healthy alternatives in vending machines/cafeteria/company meetings and promote nutrition and weight management programs.
The Quality Award
Meets Merit Award; and
Written policy in place that supports healthy food options and promotes nutrition and weight management programs; and
Provide incentive for participating in nutrition or weight management
The Excellence Award
Meets Quality Award; and
Provides on-site programming to support healthy eating and /or weight management.
Bonus Category
Written policy for Breastfeeding in the Work Place
Promotion of Health Screenings - i.e.: cholesterol, mammograms, prostate, etc.
Description
Date(s)
Employee Assistance Program
Drug -Free Workplace Policy
Healthy Eating written policy encourages the use of local foods when appropriate and available.
Please list all program activities and mail or fax your written policies directly to Healthy Androscoggin.
Company/Organization Name:
Number of employees:
Contact:
Title:
Address:
City:
State:
Zip:
Phone:
Fax:
E-mail:
I am applying for at least one category and level of award. I will be sending our tobacco-free policy.
I'd like assistance in qualifying for an award.
Please call me - I'd like more information.
Yes, I am willing to share my experience with Work Healthy
Please mail or fax your written policies to:
Healthy Androscoggin
300 Main Street
Lewiston, ME 04240
Fax: (207) 795-5992
See the
Work Healthy Brochure
for guidelines and recognition information
Ph: (207) 795-5990 • Fax: (207) 795-5992 •
info@healthyandroscoggin.org
