Work Healthy Application

Award Categories and Levels

Work Tobacco-Free

The Merit Award

  1. Written Policy meets the Workplace Smoking Act of 1985 - Use of cigarettes, pipes, cigars is prohibited and also prohibited in employer vehicles; and
  2. Promote tobacco-free lifestyles by providing employees with self-help materials or referral information on quitting tobacco use; and
  3. Signs are posted that state the tobacco policy

The Quality Award

  1. Meets Merit Award; 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.

The Excellence Award

  1. Meets Quality Award; 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

The Merit Award

  1. Promote exercise and recreational activities to employees..

The Quality Award

  1. Meets Merit Award; and
  2. Written policy in place that supports exercise and recreational activities; and
  3. Provide incentives for engaging in exercise and recreational activities, and/or provide discounts/offer reimbursements for participation in fitness programs.

The Excellence Award

  1. Meets Quality Award; and
  2. Provide on-site programming that support exercise and recreational activities.

Promote Healthy Eating

The Merit Award

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

The Quality Award

  1. Meets Merit Award; and
  2. Written policy in place that supports healthy food options and promotes nutrition and weight management programs; and
  3. Provide incentive for participating in nutrition or weight management

The Excellence Award

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

Work Healthy for 2010

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-codennnnn-nnnn
Phone Number(nnn)nnn-nnnn xnnnn
Fax number(nnn)nnn-nnnn
*(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)

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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