Healthy Androscoggin

http://healthyandroscoggin.org/work-siteemployers/work-healthy/work-healthy-application/
March 18,2010 0:16:29

Work Healthy Application

Award Categories and Levels

Written Policy meets the Workplace Smoking Act of 1985 - Use of cigarettes, pipes, cigars is prohibited 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

Meets Merit Award; and
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
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.

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.

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.

Offer healthy alternatives in vending machines/cafeteria/company meetings and promote nutrition and weight management programs.

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

Meets Quality Award; and
Provides on-site programming to support healthy eating and /or weight management.

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

Healthy Androscoggin

300 Main Street

Lewiston, ME 04240

Fax: (207) 795-5992

	Award Categories: Select the Award level you are applying for (See qualifications above).
	Work Tobacco Free
		The_Merit_Award The_Quality_Award The_Excellence_Award
	Encourage Physical Activity
		The_Merit_Award The_Quality_Award The_Excellence_Award
	Promote Health Eating
		The_Merit_Award The_Quality_Award The_Excellence_Award
	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)