COMMITTEE WORKBOOK

COMMITTEEWORKBOOK

CommitteeWorkbook

I. What Is a Worksite Wellness Program? . . . . . . . . . . . . . . . . . .1

II. What Is a Worksite Wellness Committee? . . . . . . . . . . . . . . . .3

III. What Is the NC HealthSmart Worksite Wellness Toolkit? . .5

IV. Establishing and Maintaining a Worksite Wellness . . . . . . .9CommitteeStep 1. Identifying Committee Members . . . . . . . . . . . . . . . . . . . . . . . . .12Step 2. Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13Step 3. First Meeting—Establishing the Committee . . . . . . . . . . . . . . . . . .14Step 4. Second Meeting—Obtaining Employee Opinions . . . . . . . . . . . .18Step 5. Third Meeting—Developing an Action Plan . . . . . . . . . . . . . . . . .22Step 6. Fourth Meeting—Updating Program Progress . . . . . . . . . . . . . . .25Step 7. Fifth Meeting—Updating and Evaluating Program Progress . . . . .26Step 8. Year End Meeting—Evaluating Overall Program . . . . . . . . . . . . .28

V. Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Appendix A: Multi-Level Approach to Changing Behavior . . . . . . . . . . .32Appendix B: NC HealthSmart Worksite Wellness Program Model . . . . .33Appendix C: Worksite Wellness Committee Action Plan Template . . . . . .34Appendix D: Worksite Wellness Committee Action Plan Sample . . . . . . .37Appendix E: Sample Letter of Invitation to Serve . . . . . . . . . . . . . . . . . .42

on the Worksite Wellness CommitteeAppendix F: Worksite Wellness Committee Member Invitation Poster . . .43Appendix G: Worksite Wellness Committee Member List . . . . . . . . . . . .44Appendix H: First Meeting—Sample Agenda . . . . . . . . . . . . . . . . . . . .45Appendix I: Employee Interest Survey . . . . . . . . . . . . . . . . . . . . . . . . .46Appendix J: Policy and Environment Survey . . . . . . . . . . . . . . . . . . . . .48Appendix K: Meeting Icebreakers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50Appendix L: NC HealthSmart Workbook Overviews . . . . . . . . . . . . . . .52Appendix M: Sample Mission Statements . . . . . . . . . . . . . . . . . . . . . . . .55Appendix N: Committee Members and Role Sharing Ideas . . . . . . . . . .56

TABLE OF CONTENTS

TABLE OF CONTENTS, CONTINUED

Appendix O: Worksite Wellness Committee Announcement Poster . . . . .57Appendix P: Cover Letter for Employee Interest Survey . . . . . . . . . . . . .58Appendix Q: Employee Interest Survey Distribution and Collection . . . . .59

SuggestionsAppendix R: Second Meeting—Sample Agenda . . . . . . . . . . . . . . . . . .60Appendix S: Score Sheet for Employee Interest Survey . . . . . . . . . . . . .61Appendix T: Score Sheet for Policy and Environment Survey . . . . . . . . .63Appendix U: Employee Evaluation of a Worksite Activity . . . . . . . . . . . .64Appendix V: Employee Satisfaction with Worksite Wellness Program . . .65Appendix W: Employee Satisfaction Survey Results Form . . . . . . . . . . . .66Appendix X: Evaluation of Wellness Committee . . . . . . . . . . . . . . . . . . .67

by Committee MembersAppendix Y: NC HealthSmart Workbook Wellness Toolkit . . . . . . . . . . .68

Evaluation Form

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SECTION IWhat Is a WorksiteWellnessProgram?

A WORKSITE WELLNESS PROGRAM is an organ-ized program for employees (and indirectly, theirfamilies) designed to enrich their physical, mental,emotional, occupational and spiritual well-being.

A major goal of the program is to make the workenvironment more supportive of positive healthbehaviors of employees and thereby reduce theirrisk of developing chronic diseases. The concept ofwellness, however, goes beyond reducing diseaseand includes promoting and supporting improvedwell-being for all employees.

Even healthy employees will welcome theopportunity to work in an environment that sup-

ports their healthy lifestyle goals. WorksiteWellness activities can help all employees increasetheir energy and reduce stress.

The NC HealthSmart Worksite Wellness Toolkitprovides the resources and tools to conduct work-site wellness programs and activities. Theseresources and tools have been designed utilizing a multi-level approach to health promotion thataffects individuals’ decisions and abilities to prac-tice positive behaviors or to make needed lifestylechanges. (Share Appendix A and Appendix B withcommittee members.)

2 NORTH CAROLINA HEALTHSMART WORKSITE WELLNESS TOOLKIT

What Is a Worksite Wellness Program?

THE NC HEALTHSMART TOOLKITFOCUSES ON THE FIRST THREE LEVELS OF CHANGE:

Individual—Motivating change in individualemployee behavior by increasing knowledge, influencing attitudes or challenging beliefs.

Examples: Employees take the steps instead of the eleva-tor, quit smoking, and bring a healthy lunch three times aweek instead of eating out.

Interpersonal (Groups)—Recognizing that groups at theworksite can provide social identity and support, interpersonalactivities target groups.

Examples: Work-based weight loss program, walk-a-thon participation, supportgroup for smoking cessation, and monthly social activities for stress relief.

Organizational—Ensuring that the policies, practices, and physi-cal work environment support behavior change.Examples: Tobacco-free worksite, healthy vending machine policies,

policy setting aside time for physical activity during the workday.

KEY ITEM TO REMEMBER:As employees’ behaviors change andtheir health improves, it is critical thatthe policies, practices and physicalenvironment of the worksite alsochange to support the individualhealth improvements. One cannotachieve success and sustainabilitywithout the other.

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SECTION IIWhat Is a WorksiteWellnessCommittee?


THE WORKSITE WELLNESS COMMITTEE • is a team of employees who formally meet and plan activities to

promote good health for themselves and for their fellow workers,

• represents employees from all organizational levels,

• communicates to employees information about knownhealth risks and the value of a worksite wellness committee andwellness initiatives,

• creates and maintains open lines of communicationbetween wellness committees and employees,

• promotes participation in both individual and groupactivities,

• advocates for worksite policies and environments thatsupport improved health,

• coordinates the monitoring and evaluationof the wellness activities/programs offeredto employees, and

• serves as the leader/champion for wellnessactivities at their worksite.

The NC HealthSmart Toolkit provides theresources and tools for worksite wellnesscommittees to establish, maintain and sustaina successful worksite wellness program.

What Is a Worksite Wellness Committee?What Is a Worksite Wellness Committee?

WORKSITE WELLNESS—COMMITMENT AND SUPPORTEstablishing, supporting and maintaining a work-site wellness committee provides opportunities forall employees (both management and support) to:

• create a healthy worksite;• foster collaboration and partnerships; and• establish healthy lines of communication

between support staff, line supervisors, middleand top management.

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SECTION IIIWhat Is the NC HealthSmartWorksite WellnessToolkit?

THE NC HEALTHSMART WORKSITE WELLNESSTOOLKIT is an all-in-one resource for establishinga worksite wellness program for employees thatpromotes and supports eating healthy, increasingphysical activity, quitting the use of tobacco andreducing stress.

It is designed for employees to create wellnesscommittees that promote individual behaviorchange, as well as policy and environmentalchanges that support good health for all employees.

The toolkit is organized into five workbooks:1. Worksite Wellness Committee Workbook2. Eat Smart3. Move More4. Quit Now5. Manage StressEach of the workbooks, described below, is a

comprehensive collection of ready-to-use programmaterials for promoting worksite wellness.


What Is the NC HealthSmartWorksite Wellness Toolkit?What Is the NC HealthSmartWorksite Wellness Toolkit?

WORKSITE WELLNESS COMMITTEE WORKBOOKThe key to a successful worksite wellness program is the establishment of an organized and productive worksite wellnesscommittee. This workbook outlines the step-by-step process forestablishing and maintaining a wellness committee, defines committee responsibilities and provides ready-to-use meetingagendas, worksite surveys, program evaluation tools and otherresources.

The remaining four (4) resource workbooks each include the following sections:

• HealthStart Activity—an activity that includes ready-to-usematerials, such as announcements, posters, handouts, etc.This activity focuses on individual behavior change and canbe used to “jumpstart” worksite wellness committees’ efforts and program activities that help achieve short-term success for your wellnessprogram.

• Resources for Individuals and Groups• Resources for Worksite Policies• Resources for Worksite Environments• Other Resources

A brief description of each resource workbook follows.

EAT SMART The food we eat directly and indirectly affects our physical andmental well-being. It is the fuel that keeps our bodies going. A healthy eating pattern can help to prevent several chronic diseases and conditions including heart disease, stroke, somecancers, diabetes, high blood pressure, arthritis, osteoporosisand depression. Furthermore, a balanced diet combined withadequate physical activity helps to achieve energy balance and isthe most important factor in maintaining a desirable body weight.

The Eat Smart workbook offers a wide range of resources forindividual/group activities, as well as policy and environmentalchanges that encourage all employees to eat healthy. The appen-dices provide ready-to-use sample policies, posters, signs, let-ters, one-page handouts, healthy foods lists, recipes, etc.

MOVE MOREPhysical activity helps to enhance the quality of life for people of allages and abilities. Sedentary individuals can substantially reduce therisk of developing heart disease, diabetes, osteoporosis and coloncancer just by becoming moderately physically active on most daysof the week.

A physically active lifestyle can help to reduce the risk of developing heart disease, diabetes and certain cancers. It alsoreduces heart disease risk factors such as high cholesterol, hyperten-sion and overweight as well as protect against stroke. It helps tobuild a healthier body by strengthening bones, muscles and joints,aiding in reducing depression and anxiety, enhancing the response ofthe immune system and reducing falls among older adults. Physicalactivity is associated with fewer hospitalizations, physician visits,and medications. Moreover, physical activity need not be strenuousto be beneficial; people of all ages can benefit from participatingin regular, moderate-intensity physical activity, such as 30 minutes of brisk walking on most days of the week.

The workbook offers a wide range of resources for individual/group activities, as well as policy and environmental changesthat encourage all employees to Move More. The appendicesprovide ready-to-use sample policies, posters, signs, letters,one-page handouts, questionnaires, sign-in sheets, pledge card,walking log, etc.

QUIT NOWTobacco use is the number one preventable cause of death in theUnited States. Tobacco use in any form is not only harmful for theperson using the product but also for non-smokers and other peo-ple in the environment.

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Some of the proven health consequences of tobacco use include prema-ture death, disability and disease including heart disease, stoke, severalcancers, chronic bronchitis and emphysema. Tobacco use is also a cause

of intrauterine growth retardation leading to lowbirth weight babies and a probable cause of unsuc-cessful pregnancies.

In view of the above mentioned health hazards,and that tobacco use can lead to nicotine addition,it makes common sense to quit tobacco use.However, it is also true that once addicted to nico-tine it is not easy to quit tobacco use. Since employ-ees spend a lot of time at their work, worksites canhelp interested employees to quit tobacco use bytaking steps to make the worksite tobacco free. Atobacco free policy/environment at the worksite canbe a huge incentive to help employees quit.

The workbook offers a wide range of resourcesfor individual/group activities, as well as policy and

environmental changes that encourage all employees to Quit Now. Theappendices provide ready-to-use sample policies, posters, signs, letters,one-page handouts, worksite surveys, success stories, pledge card, listingof free resources, etc.

MANAGE STRESSThe worksite wellness committee can initiate programs andactivities to help employees manage their stress and gain skillsto manage the demands of the work environment. Stress is a nat-urally occurring reaction of your body to psychological or phys-ical demands of the environment. Stress reaction increasesblood pressure, heart rate and respiration as well as otherchanges to major body systems. These reactions prepare thebody for “fight or flight” from physically dangerous or psycho-logically threatening situations. The causes of stress reaction inthe workplace include task demands, time demands, physicaldemands, role demands and interpersonal demands.

The workbook offers a wide range of resources for individual/ group activities, as well as policy and environmental changes thatsupport employees’ efforts to manage stress. The appendicesprovide ready-to-use Manage Stress group activities, sampleposters, signs, one-page handouts, listing of free resources, etc.


The entire con-tents of the NCHealthSmartWorksite Wellness

Toolkit, includingall the workbooks

and appendices, are included in the CDprovided with the Toolkit. Please feelfree to make copies of this CD and shareamong the worksite wellness committeemembers.

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SECTION IVEstablishing andMaintaining aWorksite WellnessCommittee


THE NC HEALTHSMART WORKSITE WELLNESSTOOLKIT recommends the following steps to estab-lish a successful worksite wellness committee and tosupport healthy lifestyle behaviors among the work-site employees.

THE STEPS:1. Identifying Committee Members

2. Getting Started

3. First Meeting—Establishing the Committee

4. Second Meeting—Obtaining EmployeeOpinions

5. Third Meeting—Developing an Action Plan

6. Fourth Meeting—Updating Program Progress

7. Fifth Meeting—Updating Program Progress

8. Year End Meeting—Evaluating Committee Activities

Step-by-Step Instructions

April 06IdentifyCommitteeMembersand GettingStarted

May 06Establishinga WorksiteWellnessCommittee

July 06CompletingWorksiteSurveys

Sept 06Developingan ActionPlan

Nov 06UpdatingProgramProgress

Jan 07UpdatingProgramProgress

March 07Completingthe 12MonthEvaluation

April 07IdentifyingCommitteeMembers,etc.

Steps 1 & 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 Step 1

A Year in the Life of a Worksite Wellness Committee


WORKSITE WELLNESS COMMITTEE—Key Items to Remember

• In order to establish an effective worksite wellness committee, the committee membersshould plan to complete the steps in the Worksite Wellness Committee Workbook over atwelve-month period. The proposed steps are flexible and can be altered to accommodate theneeds of your worksite wellness committee.

• There are a minimum of six recommended meetings that should be held within this time period.This timeline may need to be expanded, for example, to include at least one meeting permonth lasting at least one hour in duration. The number of meetings may depend on surveyresults and findings by the worksite wellness committee.

• The Worksite Wellness Committee Action Plan (Appendix C and Appendix D) is critical to theguidance and success of program activities, the evaluation of those activities and reportingresults to management.

• After the wellness committee has completed the first year, the committee can continue to usethe workbook as a guide for years two, three and so on.

• The committee workbook has been created so that committee members can rotate off andnew employees can rotate onto wellness committees. The committee workbook is an easy tofollow guide for new committee members and helps to ensure sustainability of the worksitewellness program.

• Worksites that have an established wellness committee can utilize this workbook as a resourceto review their current committee work and are encouraged to use these tools to enhancetheir committee work.

• All committees—new or established—can utilize the agendas, surveys, resources and ideasprovided in the toolkit.


MANAGEMENT CAN INITIALLY IDENTIFY com-mittee members, although the NC HealthSmartWorksite Toolkit is designed so that any employeecan initiate the process of establishing a WorksiteWellness Committee at their worksite.

In most cases the person completing Step 1and Step 2 would be the person who attended theWorksite Wellness Toolkit Training session.

If the toolkit has been used previously and thisis a second or third implementation, the worksitewellness committee members have the option tostay on the committee or rotate off their responsi-bility to new members.

Identifying committee members can be accom-plished in two ways—by invitation and/or solicit-ing volunteers.

The supervisor, manager or employeewho attended the Worksite WellnessToolkit Training and received the toolkitcan:

1. Identify employees to serve on theworksite wellness committee. Theseemployees should be asked, in personor by letter, about their willingnessand interest to serve. See Appendix Efor a sample invitation letter.

and/or

2. Solicit volunteers by placing announce-ments in high traffic locations, throughemployee newsletters, email, etc.Committee members who volunteercan become program “champions”encouraging success for the entireworksite. Volunteer employees havethe potential to bring increased energy

to the committee.See Appendix F for a sample committeemember invitationannouncement.

Once committeemembers have beenidentified, be sureto complete the WorksiteWellness CommitteeMembers’ form(Appendix G) listing com-mittee members’ names and their supervisor’sapproval.

IDENTIFYING COMMITTEE MEMBERS—Key Items to Remember• Number of Committee Members—It is suggested that you

have at least four (4) to twelve (12) committee members,although the maximum number of members may depend onthe size of your worksite and the level of employee interest.

• Suggested Committee Members—Be sure to include com-mittee members from human resources, information systems,all levels of management, administrative and support staff.

• Existing Committees—Be sure to check and see if you haveany existing committees, such as a safety committee, and tar-get those members for invitation.

• Supervisor Approval—All committee members need tohave their immediate supervisor’s support for the time andwork they dedicate to the wellness committee.

• Work Plan Revision—Employees will need to revise theirannual work plan to reflect the new duties of serving on thewellness committee.

Step 1: Identifying Committee MembersStep 1: Identifying Committee Members

AS A MEMBER OF MANAGEMENT AND/OR ANEMPLOYEE who has completed Step 1 for yourworksite, Step 2 may seem relatively simple innature, but it is the MOST CRITICAL step you will take in the promotion of good health to allemployees where you work.

Scheduling Meeting 1• Be sure to select a time, date and

place that is convenient for all com-mittee members. Allow two hoursfor this initial meeting, and as youwill see in Step Three, this amountof time is essential in establishingan effective and organized worksitewellness committee.

• The person who attended the Worksite WellnessToolkit Training session may serve as the conven-ing person for Meeting 1.

• Step 3 provides the detailed purpose for thismeeting along with a sample agenda that can befollowed.


GETTING STARTED—Key Items to RememberA CD-ROM is located in the front cover of the NCHealthSmart Toolkit. The CD includes all the informationin each workbook in the toolkit. This CD can be copiedand distributed to committee members during the firstcommittee meeting. All files are available in PDF format fordownloading and printing. All agendas, letters, posters, aswell as all the resources are available for easy use.

Step 2: Getting StartedStep 2: Getting Started


AS A MEMBER OF MANAGEMENT AND/OREMPLOYEE who has been selected to convene thefirst meeting of the worksite wellness committee,you should provide an overview/orientation toother committee members about the organizationand utilization of the worksite wellness toolkit. Thistask should be accomplished in the first committeemeeting.

The objectives and detailed points of discussionfor the first meeting are provided below. A sampleagenda for the meeting is also provided inAppendix H. It can be printed from the toolkit CDfor distribution during the committee meeting. Youcan also modify the objectives and the agenda tobetter suit the needs and organization of your par-ticular worksite.

Meeting Objectives• Overview and orientation of worksite wellness

program and toolkit

• Identify worksite wellness committee chairper-son and program coordinator

• Select a name for the committee and write a mis-sion statement (Appendix M)

• Develop a communication plan to announce theprogram/activities to employees

• Introduce the Worksite Wellness CommitteeAction Plan (Appendices C and D)

• Introduce Employee Interest Survey (Appendix I)

• Introduce and distribute Policy & EnvironmentalSurvey to committee members (Appendix J)

Step 3: First Meeting—Establishing the Committee

Agenda Items1. Call meeting to order (5 minutes)The employee convening the meeting should ask for a volunteer torecord the minutes of the meeting.

2. Introductions—Committee Members (10 minutes)Each employee introduces himself or herself and shares one favoritefood and one favorite physical activity. (See Appendix K for additionalphysical activity breaks.)

Committee Communication: Pass around a sheet of paper for everyoneto sign that lists their email address and phone number.

3. Orientation to the NC HealthSmart Worksite Wellness Toolkit (20minutes)

Introduce the NC HealthSmart Worksite Wellness Toolkit to committeemembers.• Multi-level Approach to Change (Appendix A)• NC HealthSmart Program Overview (Appendix B)

Step 3: First Meeting—Establishing the Committee

• Overview of the five (5) workbooks (Appendix L):—Worksite Wellness Committee —Eat Smart —Move More—Quit Now —Manage Stress

At this point, you may also distribute copies of the CD-ROM provided withthe toolkit, if you decide to do so. This would give the committee mem-bers the option of reviewing the toolkit contents at their convenience.

4. Committee Name (10 minutes)Select a name for the worksite wellness committee.

Name ______________________________________________________________

5. Mission Statement (15 minutes)The mission statement should be a globalexpression of what the Worksite WellnessCommittee wants to accomplish using theNC HealthSmart Toolkit. The mission state-ment may include a description of the valueof the program to the worksite and to itsemployees. You may decide on a missionstatement that reflects the work the commit-tee wants to accomplish. Some examples ofmission statements are given on the rightand in Appendix M. You may choose toselect one from these or create your own.

6. Selection of Committee Chairperson(10 minutes)

Select the Worksite Wellness CommitteeChairperson. The chairperson is responsiblefor conducting the meeting(s) and handlingany administrative paperwork and reportingfor the committee.

Committee Chairperson:

________________________________________

This person will:

• not need a background in health—thetoolkit resources are self-directing,

• send committee meeting reminders, meeting minutes and other detailsdocumenting the wellness committee’s work,

• distribute, collect and score the Policy and Environmental Survey (thissurvey is completed by committee members only—Appendix J),

• coordinate employee program activities, with the help of the programcoordinator (see page 16) and,

• submit documents to management for program evaluation such as notesor minutes from meetings, simple email messages, etc.


Mission Statement Examples• “The mission of the (name of worksite) Worksite

Wellness Committee is to establish and maintain aworksite that encourages environmental and socialsupport for a healthy lifestyle.”

• “To encourage employees’ personal and professionalproductivity, and physical and mental well-being, themission of the (name of worksite) Worksite WellnessCommittee shall be to promote a worksite culture thatsupports employees’ desire to make healthy lifestylechoices.”

• “Because employees spend 40 hours a week at work,it is important that the worksite be a healthy place towork and support healthy choices for employees. It isthe mission of the (name of worksite) WorksiteWellness Committee to work toward implementingpolicies that support a healthy worksite and healthyemployees.”

• “The worksite wellness committee will work to provideopportunities for employees to develop healthierlifestyles by supporting the adoption of habits and atti-tudes that contribute to their positive well-being.”


7. Selection of the Worksite Wellness Program Coordinator. (10 minutes)The program coordinator (one or more persons for large worksites—see Appendix N for role sharing ideas) will serve as the overall coordinatorfor the program activities.

Program Coordinator(s):

___________________________________________________________________

This person will:

• not need a background in health—the toolkit resources are self-directing,

• devote time in his or her regular work schedule to address coordinationresponsibilities,

• distribute, collect and score the Employee Interest Survey (Appendix I)which will be distributed to all employees at the worksite (Appendix Qfor methods of distribution, collection and scoring of surveys), and

• coordinate employee program activities, with the help of the commit-tee chairperson and/or other program chairs as assigned.

8. Employee Communication Plan(10 minutes)

Establish a plan for communicating withemployees that• announces the formation (or continuation)

of the wellness committee (Appendix O),

• provides information to employees aboutupcoming programs and events, and

• provides employees with periodic updatesabout the worksite wellness program.

9. Action Plan Template and Sample(5 minutes)

Provide a copy of the Worksite WellnessCommittee Action Plan Template (Appendix C) and Action Plan Sample(Appendix D) for committee members to review for the next meeting.

10. Employee Interest Survey (10 minutes)Provide a copy of the Employee Interest Survey (Appendix I) andthe accompanying cover letter (Appendix P) to all committee mem-bers to review before the next meeting.

The results of this survey will help the committee determine theshort-term goals (or strategies) for the Worksite Wellness CommitteeAction Plan.

Ask that committee members review the survey and think abouthow this survey should be distributed to employees at your worksite.This may be done personally, through email, mailboxes or some otherpractical means depending upon the size of your worksite and thenumber of employees. (See Appendix Q for suggested survey distribu-tion and collection suggestions.)

Examples of ways to communicatewith employees include:

• Kick-off events• Announcements

through agency“intranet” service

• Posters on bulletinboards, entrance doorsand restroom doors

• Newsletter articles

• Email announcements• Employee letters• Payroll stuffers• Intercom announce-

ments• Staff meetings• Employee celebrations

11. Policy & Environmental Survey (10 minutes)Distribute a copy of the Policy and Environmental Survey to the committeemembers. The committee members need to complete this survey andreturn to the committee chair by a specified date (before the next meetingso the chair will have time to compile the results for discussion at thatmeeting).

The results of this survey will help the committee determine the long-term goals (or strategies) for the Worksite Wellness Committee Action Plan.

12. Schedule Future Meetings (10 minutes)It is recommended that the committee members schedule the future fivecommittee meetings at this point. The second meeting should be scheduledwithin one month of the first meeting. The following timeline is suggestedover a twelve-month period:

• Second meeting—month 2 (allow 60-90 min)

__________________________________________________________________

• Third meeting—month 3

__________________________________________________________________

• Fourth meeting—month 6

__________________________________________________________________

• Fifth meeting—month 9

__________________________________________________________________

• Year-end meeting—month 12

__________________________________________________________________

13. Adjourn

Reminder: Chairperson needs to send a meetingreminder notice to all committee members at leastone week prior to the next meeting. Minutes fromthis meeting can be included with that reminder.


As a reminder:A CD-ROM is located in the front cover of theNC HealthSmart Toolkit. The CD includes allthe information in each workbook in thetoolkit. This CD can be copied and distributedto committee members during the first com-mittee meeting. All files are available in PDFformat for downloading and printing. All agen-das, letters, posters, as well as all theresources, are available for easy use.


THE OBJECTIVES and detailed points of discus-sion for the second meeting are provided below. Asample agenda for the meeting is also provided inAppendix R. It can be printed from the toolkit CDfor distribution during the committee meeting. Youcan also modify the objectives and the agenda tobetter suit the needs and organization of your par-ticular worksite.

Meeting Objectives• Outline plan to distribute and collect the

Employee Interest Survey• Review results from the Policy & Environmental

Survey• Identify funds for incentives and materials• Discuss current and potential worksite policy for

wellness activities

OBTAINING EMPLOYEE OPINIONS—Key Items to RememberThis meeting will accomplish several major tasks for the committee:

1. The Employee Interest Survey will be discussed and distributed to all employees at yourworksite after this meeting. As a committee chairperson and/or member, it is critical that yousupport the work of your committee and encourage your fellow employees to complete thesurvey.

This is the key document for engaging employees in the wellness activities selected for theirworksite, and finding out their interests and needs will contribute to the overall success of thecommittee’s work and the worksite wellness program. The results of this survey will guide thecommittee’s short-term goals for your action plan and the selection of the HealthStart initialactivities that will be introduced at the worksite.

2. The Policy & Environmental Survey results will be reviewed to help the group develop long-term goals for the action plan regarding policy/environment changes. The results of thesurvey may very well show that there are several issues that need to be addressed; however,it is good to strive for one change at a time. As policy/environment changes are adopted(either formally or informally), new action plans can be created to address other issues.

3. Incentives and Work Time Considerations for Activities may be discussed. This will varyfrom worksite to worksite and is one of the tasks that will involve management’s input. As areminder, the toolkit is equipped with all the resources you need to start wellness activitiesat your worksite. Incentives and resources are an added bonus to your program, should theybe available.

Step 4: Second Meeting—Obtaining Employee Opinions

Step 4: Second Meeting—Obtaining Employee Opinions

Agenda Items1. Call meeting to order—Chairperson (5 minutes)It is suggested that the committee chairperson ask for a volunteer to recordthe minutes of the meeting.

2. Old Business—Chairperson (5–10 minutes)List any unfinished tasks from the previous meeting as indicated in theminutes.

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

3. Employee Interest Survey—Program Coordinator (10 minutes)

• Decide how to distribute the survey to employees at your worksite. Thismay be done personally, through e-mail, mailboxes or some other practi-cal means depending upon the size of the facility and number of employ-ees. (Review Appendix Q for information about survey distribution andcollection suggestions.)

• Decide the dates that the surveys will be distributed and when theyshould be completed and returned. Allow at least one week for employ-ees to complete and return the survey to the specified person. Also,the return date should be such that it gives a reasonable amount oftime for the Program Coordinator to compile the results for the nextcommittee meeting. Be sure to include this date on the survey in thespace provided before sending them out to the employees.

• The program coordinator distributes, collects and scores the surveyand reports the results at the next meeting. The score sheet for theEmployee Interest Survey is provided in Appendix S.

• The results of the Employee Interest Survey will be reviewed at thenext meeting and will be used by the committee to determine theshort-term goals (strategies) for the Action Plan.

(See survey table on page 27.)

4. Worksite Policy & Environmental Survey Report—Chairperson (20 minutes)

The committee chairperson should have received the completedworksite Policy and Environmental Survey from all the commit-tee members before this meeting. Also, using the survey scoresheet (provided in Appendix T), the chairperson should havearrived at the results for the survey. Discuss these results withthe committee members.


• Report the total score for each of the followingfrom the survey score sheet

Eat Smart ___________________

Move More ___________________

Manage Stress ___________________

Quit Now ___________________

• A high score in any of the sections indicates that the committee needs toconsider selecting long-term goal(s) (listed as strategies on the WorksiteWellness Committee Action Plan) for promoting policy and/or environ-mental changes at the worksite. Refer to the Sample Action Plan(Appendix D) for examples.

Next, select activities from the four (4) resource workbooks—Eat Smart,Move More, Quit Now and Manage Stress—that correspond to the commit-tee’s long-term goal(s). Refer to the Sample Action Plan (Appendix D) tosee how the strategies and steps will be reported on your action plan.

Make a list of the strategies and steps that your worksite wellness com-mittee plans to implement.


Note: The four focus areas are listed on thescore sheets in the same order as the surveyquestions. In both the Employee Interest Surveyand the Policy and Environmental Survey thetobacco use questions were listed last as not allemployees use tobacco.

Strategy 1 (Long-term goal that addresses poli-cy and/or environmental change)

Goal:______________________________________

___________________________________________

Step 1 (see resources from workbooks):

___________________________________________


___________________________________________


___________________________________________

Strategy 2 (Long-term goal that addresses poli-cy and/or environmental change)

Goal:______________________________________

___________________________________________


___________________________________________


___________________________________________


___________________________________________

Once the committee has determined the long-term goals for your worksite,record the strategies on your action plan that will be completed at the nextmeeting.

5. Management Issues—Chairperson (30 minutes)The chairperson may need to assign one or two members of the committeeto follow up on the questions below and others that might arise during dis-cussion for reporting at the next meeting.

Funding for incentives and materials—Chairperson (15 minutes)

1. Is funding available from management?

_________________________________________________________________________________

_________________________________________________________________________________

2. Is there any funding available from outside sources?

_________________________________________________________________________________

_________________________________________________________________________________

Worksite policy for wellness activities—Chairperson (15 minutes)

1. Who has authority to approve time considerations for activities during regular workhours?

_________________________________________________________________________________

_________________________________________________________________________________

2. What might be the restrictions regarding wellness activities at the worksite?

_________________________________________________________________________________

_________________________________________________________________________________

3. How much time is allowed for wellness activities—if any? Examples: 30 minutes peremployee 3 times a week; 15 minutes per employee daily paired with established breaktime; 1 hour all employees once a month for group activity.

_________________________________________________________________________________

_________________________________________________________________________________


6. Next meeting date(s)—Program Coordinator (10minutes)The committee may have already decided thedates for the upcoming meetings during the firstmeeting. However, it would be beneficial to reviewthese dates once again, both as a reminder and toprovide an opportunity for any changes.

Third meeting: ___________________

Fourth meeting: ___________________

Fifth meeting: ___________________

Year-end meeting: ___________________

7. Adjourn


Meeting Objectives• Review results from the Employee Interest Survey• Identify short-term goals (based on Employee

Interest Survey)• Review long-term goals (based on Policy and

Environmental Survey)• Create an Action Plan for your worksite wellness

program • Schedule follow-up meeting to check progress

Agenda Items1. Call meeting to order—Chairperson (5 minutes)It is suggested that the committee chairperson askfor a volunteer to record the minutes of the meet-ing.

2. Old Business—Chairperson (5-10 minutes)List any unfinished tasks from the previous meet-ing as indicated in the minutes.

______________________________________________

______________________________________________

______________________________________________

3. Employee Interest Survey Report—ProgramCoordinator (20 minutes)

The Program Coordinator should have received allthe completed Employee Interest Surveys from theemployees at the worksite before this meeting.Also, using the survey score sheet (Appendix S),the Program Coordinator should have arrived atthe results for the survey.

(Note: The Coordinator may have asked for helpfrom one or two other committee members to ana-

lyze the results of this survey, depending upon thesize of the worksite and the response rate for thesurvey. See Appendix Q for additional suggestions.)

Discuss these results with other committee mem-bers.

• Total # of Surveys Distributed_________________• Total # of Surveys Returned___________________

The score for each of the questions in the EmployeeInterest Survey reflects the level of employee inter-est in that particular area. High numbers indicatehigher level of interest. As a team look at the scoresand identify the areas that your worksite wellnesscommittee would like to address first.

Report the total score for each of the followingfrom the survey score sheet

Eat Smart ___________________

Move More ___________________

Manage Stress ___________________

Quit Now ___________________

A high score in any of the sections indicates thatthe committee needs to consider selecting short-term goal(s) [or identified as strategies on theaction plan] for promoting individual behavior


Step 5: Third Meeting—Developing an Action Plan

Step 5: Third Meeting—Developing an Action Plan

Note: The four focus areas are listed on thescore sheets in the same order as the surveyquestions. In both the Employee Interest Surveyand the Policy and Environmental Survey thetobacco use questions were listed last as not allemployee use tobacco.

change of employees. Refer to the Sample ActionPlan (Appendix D) for examples.

Next, select activities that correspond to thecommittee’s short-term goal(s) from the HealthStartactivities that appear in the front of each of theresource workbooks—Eat Smart, Move More, QuitNow and/or Manage Stress. The HealthStart activi-ties are provided to allow a “jumpstart” on imple-menting committee activities. The committee canalso utilize any of the activities found throughoutall the resource workbooks.

Refer to the Sample Action Plan (Appendix D)to see how the strategies and steps will need to bereported on your action plan.

Make a list of the strategies and steps that yourworksite wellness committee plans to implement.

Strategy 1 (Short-term goal that addresses policyand/or environmental change)

Goal:________________________________________

____________________________________________


_____________________________________________


_____________________________________________


_____________________________________________

Strategy 2 (Short-term goal that addressespolicy and/or environmental change)

Goal: __________________________________

_______________________________________


_____________________________________________


_____________________________________________


_____________________________________________

Once the committee has determined the short-term goals for your worksite, the strategies andsteps are ready to be recorded on your action plan.

4. Developing the Action Plan—Chairperson (20minutes)

Record the following information on WorksiteWellness Committee Action Plan (Appendix C):

• Worksite• Committee Name• Committee Chairperson• Program Chair• Other Chairs• Mission Statement• Communication Plan• Committee Members• Short-Term Goals—Strategies and Steps

Determine committee members responsiblefor each strategyDecide date of implementationResults (Outcomes)—to be completed aftereach activity

• Long-Term Goals—Strategies and StepsDetermine committee members responsiblefor each strategyDecide date of implementationResults (Outcomes)—to be completed aftereach activity

• Year-End Evaluation Summary—to be com-pleted at the last meeting

• Recommendations from the Committee—to becompleted at the last meeting

5. Evaluate Employee Program ActivitiesBe sure to think about ways to get feedback fromemployees on the individual and/or group activi-ties that you implement at your worksite. One wayis to have employees sign up for activities and pro-vide their email addresses so that once the activityis completed, you can email them a few short ques-tions about the activity.


Adopt and begin implementation of your Worksite Wellness CommitteeAction Plan.

The evaluation information collected throughemployee feedback will need to be summarized inthe Results/Outcomes section of the action plan.(See Appendix U for an example of a program/activity evaluation form.)

6. Next meeting date(s)—ProgramCoordinator (5 minutes)Remind the committee members ofthe dates for future meetings to checkthe progress of the action plan. It willalso provide an opportunity to makeany changes to the scheduled dates, ifneeded.

Fourth meeting: ______________

Fifth meeting: ______________

Year-end meeting: ______________

7. Adjourn



SIMPLE GUIDELINES FOR PROGRAMS/ACTIVITIESBe sure to document all the events associated with any ofthe programs/activities that you implement at your work-site. For example:

• Write a short summary of the program activity.

• Keep a list of all those who participate.

• Take pictures at your event. This is a great way to adver-tise and promote future events.

• As soon as the activity is completed, have employeescomplete Appendix U—Employee Program and/orActivity Evaluation survey.

• Review the evaluations and prepare a short summary ofthe successes and/or lessons learned.

• Record the information on the committee’s action plan.

Meeting Objectives:• Assess progress in the adopted action plan• Change or revise action plan if needed• Determine if new or additional strategies and

steps should be initiated

Agenda Items1. Call meeting to order—Chairperson (5 minutes)It is suggested that the committee chairperson askfor a volunteer to record the minutes of the meeting.


______________________________________________

______________________________________________

______________________________________________

3. Action Plan Progress Update—ProgramCoordinator (40 minutes)

• As a team review the implementation of theaction plan that was completed during the lastmeeting. The committee members may want todiscuss whether the strategies and steps werestarted and/or completed on the specified dates and whether the employees are motivatedto participate in wellness program activities.

• Also at this point discuss any obstacles or prob-lems encountered in the implementation of theaction plan. This meeting should serve as anopportunity for the worksite wellness committee

to revise or update the action plan to better suitthe needs of their worksite and employees. Thecommittee should discuss the need for anychanges to current strategies or addition of newstrategies that would help to improve the effec-tiveness of the worksite wellness program. Theaction plan should be updated to reflect anychanges or additions.

______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

4. Next meeting date(s)—Program Coordinator (5minutes)

Remind the committee members of the dates forupcoming meetings to check the further progressof the action plan. It will also provide an opportuni-ty to make any changes to the scheduled dates, ifneeded.

Fifth meeting: _____________________

Year-end meeting: _____________________

5. Adjourn



Step 6: Fourth Meeting—Updating Program Progress

Step 6: Fourth Meeting—Updating Program Progress

Meeting Objectives• Assess progress in the adopted action plan• Change or revise action plan if needed• Determine if new or additional strategies and

steps should be initiated• Decide on the overall worksite wellness program

evaluation plan

Agenda Items1. Call meeting to order—Chairperson (5 minutes)It is suggested that the committee chairperson askfor a volunteer to record the minutes of the meeting.


______________________________________________

______________________________________________

______________________________________________

3. Action Plan Progress Update—ProgramCoordinator (25 minutes)

• As a team review the implementation andprogress of the action plan. The committee members may want to discuss whether thestrategies and steps were completed on the specified dates and whether it is being acceptedby the employees at their worksite.

• Also at this point discuss any obstacles or prob-lems encountered in the implementation of theaction plan. This meeting should serve as an

opportunity for the worksite wellness committeeto revise or update the program action plan tobetter suit the needs of their worksite andemployees. The committee should discuss theneed for any changes to current activities or addi-tion of new activities that would help to improvethe effectiveness of the worksite wellness pro-gram. The action plan should be updated toreflect any changes or additions.

______________________________________________

______________________________________________

______________________________________________

______________________________________________

______________________________________________

4. Overall Evaluation Plan—Chairperson(15 minutes)The worksite wellness committee should decide ona plan to evaluate the results of the overall wellnessprogram conducted at the worksite. The commit-tee can obtain information about the effectivenessof the activities completed at their worksite by:

• repeating the Policy and Environment Survey bycommittee members (Appendix J), and

• conducting the Employee Satisfaction Survey(Appendix V).

Since the next committee meeting will be the lastone for the current program year, these surveysshould be conducted before then. This will allowthe committee members time to discuss the resultsof the surveys and have program evaluation infor-mation to share during the last meeting.


Step 7: Fifth Meeting—Updating andEvaluating Program Progress

Step 7: Fifth Meeting—Updating andEvaluating Program Progress

Decide on the dates that these surveys will be distributed,collected and analyzed and the person(s) responsible.


Survey Distribution Date/ Collection Date/ Analysis Date/Responsible Member Responsible Member Responsible Member

Policy & Environment Survey

Employee Satisfaction Survey

5. Next meeting date(s)—Program Coordinator (5 minutes)

Remind the committeemembers of the date for thenext meeting to evaluate theimpact and results of theintervention(s) done to pro-mote worksite wellness. Itwill also provide an oppor-tunity to make any changeto the scheduled date, ifneeded.

Year-end meeting:

_______________________

6. Adjourn

Reminder: Chairpersonneeds to send a meetingreminder notice to all com-mittee members at least oneweek prior to the next meet-ing. Minutes from this meet-ing can be included withthat reminder.

NOTES FOR CREATING THE PROGRAM EVALUATION PLAN• The Policy and Environment Survey should be completed by work-

site wellness committee members only. The Employee SatisfactionSurvey (Appendix V) should be distributed to all employees at theworksite. (See Appendix Q for distribution and collection sugges-tions.)

• Select the distribution dates about one month before the scheduleddate for the year-end meeting.

• Also, the date by which the committee members/employees returnthe completed surveys should be at least two weeks prior to thelast meeting. This would give enough time to the committee mem-ber(s) responsible for analyzing the surveys.

• The completed Policy and Environment Surveys can be scoredusing the score sheet provided in Appendix T. Ideally, the resultsshould show improved scores in the wellness topic that was target-ed for intervention.

• Before distributing the Employee Satisfaction Survey to employees,clearly specify the return date and name of the person responsiblefor collecting the surveys.

• Depending upon the number of employees at your worksite, theanalysis of completed Employee Satisfaction Surveys may needtime input from more than one committee member.

• The results of the completed Employee Satisfaction Surveys can bereported using the outline provided in Appendix W. This will helpsimplify the evaluation of wellness program/activities during theyear-end committee meeting.

Meeting Objectives• Complete Year-End Evaluation Summary

Evaluate the Worksite Wellness Program using the—Action Plan Results/Outcomes—Employee Satisfaction Survey—Policy and Environment Survey (Repeat)

Provide recommendations from the Committeefor the next year

• Complete NC HealthSmart Worksite WellnessToolkit Evaluation Form

• Schedule the Worksite Wellness Committee firstcommittee meeting for the upcoming year.

Agenda Items1. Call meeting to order—Chairperson

(5 minutes)It is suggested that the committee chairper-son ask for a volunteer to record the minutesof the meeting.

2. Year-End Evaluation Summary ofWorksite Wellness Program—Chairperson (20 minutes)

• The program chair should report from theaction plan the results/outcomes of allactivities and/or programs initiated.

• The committee member(s) responsible forcollection and analysis of the EmployeeSatisfaction Survey and the repeat Policyand Environment Survey should presentthose results to the committee.

Employee Satisfaction Survey results may bereported using the outline provided inAppendix W. The committee as a group shoulddiscuss and summarize the results as recom-mendations for the next year’s worksite well-ness program.

Successes: __________________________________

____________________________________________

____________________________________________

____________________________________________

Barriers: ____________________________________

____________________________________________

____________________________________________

____________________________________________


Step 8: Year End Meeting— Evaluating Overall Program

Step 8: Year End Meeting— Evaluating Overall Program

THE PROCESS OF PROGRAM EVALUATION servesseveral purposes. It:• Helps the committee stay focused on short- and

long-term goals• Provides information for decision making on all

aspects of the program• Identifies areas where the design and delivery of

activities may need improvement or change• Increases the application of learning by participants• Allows for program accountability• Provides data on the major accomplishments of the

program• Identifies way to improve future programs

Caffarella, R. S. Planning Programs for Adult Learners. SanFrancisco: Josse-Bass, 1994.

The repeated Policy and Environment Surveyshould have been analyzed using the surveyscore sheet provided in Appendix T. Ideally, theresults should show improved scores in the well-ness topic that was targeted for intervention.

Successes: __________________________________

____________________________________________

____________________________________________

____________________________________________

Barriers: ____________________________________

____________________________________________

____________________________________________

____________________________________________

• The committee chairperson should ask for anyother recommendations to carry forward to thenext year’s committee program of work.

• The committee chairperson should complete theaction plan by recording the year-end evaluationsummary information provided above. A copy ofthe completed action plan should be sent toworksite management.

3. NC HealthSmart Worksite Wellness Toolkit (20 minutes)Evaluation—Program Coordinator (20 minutes)

The worksite wellness committee members mustalso complete the NC HealthSmart WorksiteWellness Toolkit Evaluation Survey (Appendix X).

Only one toolkit evaluation form should be com-pleted per worksite. The responses should bereported keeping in mind the overall usefulnessand effectiveness of the entire toolkit during theimplementation period. The responses to the ques-tions in the evaluation from will help to improvethe contents and effectiveness of the toolkit forfuture implementation.

These evaluations should be sent to:State Health PlanAttn: Worksite Wellness4509 Creedmoor Rd., Ste. 201Raleigh, NC 27612-3813

4. Next Year Implementation of the NC HealthSmart Toolkit—Chairperson (15 minutes)

The year-end meeting should also serve as anopportunity for the worksite wellness committeemembers to realize that it is not the end of theworksite wellness program but a time to continueto build upon enhancing the health of employees attheir worksite.

The committee members may wish to reviewthe roles and responsibilities that they fulfilled dur-ing the entire implementation period. Committeemembers may wish to continue to serve on thecommittee or may choose to step down to openspace for new members. The committee membersshould collectively decide on the date when the NCHealthSmart Worksite Wellness Toolkit will beimplemented for the next year starting from stepone as outlined in this workbook.

It is suggested that the committee compile min-utes, copies of surveys, survey reports, completedaction plan and any other documents pertinent tothe committee. These files can be recorded to CDas well as hard copies in a three-ring binder.

Step # 1 Begins (Date) _________________________Member Responsible

_____________________________________________

5. Adjourn


31

APPENDICES

CommitteeWorkbook


APPENDIX A: Multi-Level Approach to Changing Behaviors

Multi-Level Approach to Changing Behaviors

LEVEL APPLICATION

Society Developing and enforcing state policies and laws that can increasebeneficial health behaviors. Developing media campaigns that pro-mote awareness of the health needs and advocacy for change.

Examples: Partnering with NC Department of Agriculture to increasefacilities (Farmer’s Market programs) for increasing availability offruits and vegetables; passing legislative laws that all public buildingsand restaurants are smoke-free.

Community Coordinating the efforts of all members of a community (organiza-tions, community leaders, and citizens) to bring about change.Developing and enforcing local policies and ordinances that supportbeneficial health behaviors.

Examples: Forming a community coalition to assess physical activityfacilities; developing a media advocacy strategy promoting the needfor environments that support healthy eating.

Organizational Changing the policies, practices and physical environment of anorganization (e.g., a worksite, a health care setting, a school/childcare, a faith organization, or another type of community organization)to support behavior change.

Examples: Designating time for employees to work out; setting a policyabout healthy foods in worksite vending venues; establishing a tobacco-free policy at the worksite.

Interpersonal Recognizing that groups provide social identity and support, interper-sonal interventions target groups, such as family members, peers orfellow employees.

Examples: Developing buddy systems and support groups at work thatpromote weight management, walking clubs and quitting tobacco use.

Individual Motivating change in individual behavior by increasing knowledge,and influencing attitudes or challenging beliefs.

Examples: Offering cooking classes, one-on-one counseling, andincentives; promoting health coaching, interactive website, and healtheducation through displays.

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APPENDIX B: NC HealthSmart Worksite Wellness Program Model


Worksite WellnessProgram Model

SeniorManagementCommitment & Support

EmployeeEducation/Activities(Individual)and/orGroup Activities(Interpersonal)and/orPolicy &EnvironmentalSupports/Changes(Organizational)

Modifiedemployeeskills, knowledge,and attitudestoward nutrition,physical activity, tobacco useand stressmanagement

Increasedhealthy eating

Increased physical activity

Decreasedtobacco use

Decreasedstress

Increased policy andenvironmentalsupports atworksites

Reducedhealth carecosts

HealthierNorthCarolinians

NC HealthSmartWorksiteWellnessCommittees

Committee Activities Results Short-Term Long-TermOutcomes Outcomes


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2,bo

ards

in a

ll bu

ildin

gsJi

ll St

ress

—C

hair

for

Bld

g 3,

Jef

f Hug

hes—

Cha

ir fo

r B

ldg

4

OV

ER

ALL

CO

MM

UN

ICA

TIO

N P

LAN

:•

Uti

lize

the

Div

isio

n’s

intr

anet

sys

tem

and

list

serv

for

1300

em

ploy

ees

in fo

ur (

4) b

uild

ings

• Es

tabl

ish

Wor

ksit

e W

elln

ess

Bul

leti

n B

oard

s in

all

build

ings

for

flyer

s/an

noun

cem

ents

/ce

lebr

atio

ns—

plac

ed in

hig

h pr

ofile

and

str

ateg

ic lo

cati

ons

Wor

ksit

e: N

C D

ivis

ion

of P

ublic

Hea

lth

Year

#:

1

Com

mit

tee

Nam

e: W

orks

ite

Wel

lnes

s fo

r Pu

blic

Hea

lth

Empl

oyee

sC

omm

itte

e C

hair

pers

on: J

ohnn

y M

ovem

ore

Prog

ram

Coo

rdin

ator

: Sal

ly N

otob

acco

Oth

er C

hair

s:Ja

ck E

atri

ght—

Eat

Smar

t A

ctiv

ity

Cha

irJi

ll St

ress

—M

anag

e St

ress

Cha

irB

ob C

allm

e—C

omm

unic

atio

ns C

hair

Act

ion

Plan

for

Peri

od B

egin

ning

: Jul

y 1,

200

5 Pe

riod

End

ed: J

une

30, 2

006


APPENDIX D: Worksite Wellness Committee Action Plan Sample, page 2St

ep #

2—Sc

hedu

le w

eekl

y m

eeti

ngs

at lu

nch

for

Sam

e as

abo

veEm

ail t

o pa

rtic

ipan

ts

8/8/

058/

8/05

—20

em

ploy

ees

atte

nded

10 m

inut

es in

bui

ldin

g #1

for

thos

e pa

rtic

ipat

ing

to

and

flyer

s on

bul

leti

n 8/

15/0

58/

15/0

5—15

em

ploy

ees

atte

nded

shar

e in

form

atio

n/ha

ndou

ts a

nd p

rovi

de e

ncou

rage

-bo

ards

8/22

/05

8/22

/05—

7 em

ploy

ees

atte

nded

men

t. In

vite

em

ploy

ees

who

hav

e su

cces

sful

ly q

uit

the

use

of t

obac

co t

o sh

are

expe

rien

ces.

Step

#3—

Fina

l Mee

ting—

Pass

out

cer

tific

ates

to

Sam

e as

abo

veSa

me

as a

bove

8/29

/05

3 em

ploy

ees

met

the

cha

lleng

e!

thos

e w

ho m

et t

he c

halle

nge.

Ant

icip

ate

offe

ring

the

T

hose

em

ploy

ees

volu

ntee

red

to

“I Q

uit”

cha

lleng

e m

onth

ly fo

r th

e re

mai

nder

of t

he y

ear.

part

icip

ate

in t

he n

ext

chal

leng

e to

pro

vide

sup

port

for

othe

rs

and

to k

eep

them

mot

ivat

ed.

Upd

ates

to

Stra

tegy

#1

Prov

ided

“I Q

uit”

cha

lleng

es

ever

y m

onth

. A t

otal

of 3

2 em

ploy

ees

met

the

cha

lleng

e.

By

8/01

/06—

22 o

f the

em

ploy

ees

wer

e st

ill t

obac

co fr

ee!

Stra

tegy

#2:

Initi

ate

a “S

mar

t St

eps”

30

day

cam

paig

nR

espo

nsib

leC

omm

unic

atio

nD

ate

ofSh

ort-t

erm

goa

l: En

cour

age

empl

oyee

s to

incl

ude

Mem

ber(

s)to

Em

ploy

eeIm

plem

enta

tion

Res

ults

(O

utco

mes

)ph

ysic

al a

ctiv

ity

duri

ng t

he w

orkd

ay.

Step

#1—

Cre

ate

a “S

mar

t St

eps”

cha

lleng

e; h

ave

John

ny M

ovem

ore;

In

tran

et li

stse

rv

09/0

1/05

Kic

k-of

f eve

nt w

as h

eld

duri

ng

empl

oyee

s si

gn u

p; p

rovi

de p

ledg

e ca

rds;

Sa

die

Tew

; Jill

Str

ess

and

flyer

slu

nch.

Had

eve

ryon

e br

ing

a ha

ve a

kic

k-of

f eve

nt 0

9/01

/05

heal

thy

lunc

h (p

rovi

ded

idea

s fo

r br

own

bagg

ing)

. 15

7 em

ploy

ees

sign

ed u

p.

Step

#2—

Prin

t po

ster

s fr

om t

oolk

it; p

lace

@ e

leva

tors

,Sa

die

Tew

Sent

em

ail a

bout

9/

15/0

5C

heck

ed w

ith

our

grap

hic

stai

rwel

ls; h

ave

a m

id-p

oint

mee

ting

for

part

icip

ants

mys

tery

pos

ters

loca

ted

desi

gn u

nit

for

the

divi

sion

; the

y in

all

4 bu

ildin

gsw

ere

able

to

prin

t po

ster

s in

co

lor;

pur

chas

ed s

impl

e bl

ack

fram

es (

fund

s fo

r pu

rcha

sing

fr

ames

pro

vide

d by

div

isio

n of

fice)

; loc

al fi

tnes

s st

ores

do

nate

d 25

ped

omet

ers;

gav

e th

ose

as p

rize

s to

the

firs

t 25

em

ploy

ees

who

iden

tifie

d al

l 32

post

ers;

all

25 p

edom

eter

s w

ere

give

n aw

ay.

Sent

em

ail t

o th

ose

10/1

5/05

Had

ano

ther

hea

lthy

lunc

h em

ploy

ees

part

icip

atin

g br

own

bag

day

for

empl

oyee

s to

lo

g in

the

ir p

rogr

ess;

92

em

ploy

ees

atte

nded

Step

#3—

Plan

rec

ogni

tion

mee

ting

and

giv

e ou

t Ju

lie S

tres

sSe

nt e

mai

l to

11/1

5/05

Hea

lthy

lunc

h br

own

bag

even

t;ce

rtifi

cate

spa

rtic

ipan

ts

110

empl

oyee

s at

tend

ed; A

ll vo

ted

to c

onti

nue

prog

ram

; Se

lect

ed a

nam

e fo

r th

eir

“Sm

art

Step

s” g

roup

: “PH

Sm

art

Step

s”;

Mem

bers

hip

requ

irem

ent:

take

th

e st

eps

at le

ast

once

a d

ay!



Lon

g-Te

rm G

oal(

s)—

Stra

tegi

es t

hat

foc

us

on P

olic

y an

d/o

r E

nvi

ron

men

tal

Ch

ange

s

Stra

tegy

#1:

Init

iate

pos

ter

cam

paig

n fo

r th

ree

Res

pons

ible

Com

mun

icat

ion

Dat

e of

mon

ths

that

em

phas

ize

the

bene

fits

of

Mem

ber(

s)to

Em

ploy

eeIm

plem

enta

tion

Res

ults

(O

utco

mes

)a

toba

cco-

free

wor

ksit

e.Lo

ng-te

rm g

oal:

The

use

of t

obac

co a

nd/o

r sm

okin

gar

e no

t al

low

ed a

nyw

here

insi

de t

he b

uild

ing

at a

ll fo

ur w

orks

ites

.

Step

#1—

Iden

tify

bes

t lo

cati

ons

for

post

er p

lace

men

t;Je

ff H

ughe

s, C

hair

; Jac

k N

/A08

/01/

05Fu

ndin

g no

t av

aila

ble

to p

rint

pr

int

and

fram

e po

ster

sEa

trig

ht; J

imm

y B

lack

; co

lor

post

ers

or b

uy fr

ames

due

Sa

die

Tew

; Jill

Str

ess

to e

xpen

ses

alre

ady

incu

rred

with

th

e st

airw

ell p

oste

rs; c

omm

itte

e vo

ted

to p

rint

bla

ck/w

hite

po

ster

s an

d di

spla

y on

bul

leti

n bo

ards

in e

ach

build

ing

Step

#2—

30 a

nd 6

0 da

y in

terv

als;

sw

itch

pos

ters

Sadi

e Te

wN

/A10

/01/

05Sw

itch

out

pos

ters

Jim

my

Bla

ck01

/01/

0603

/01/

0605

/01/

06

Step

#3—

Surv

ey e

mpl

oyee

sJe

ff H

ughe

sSu

rvey

ed e

mpl

oyee

s 05

/01/

0646

% o

f the

652

em

ploy

ees

Jack

Eat

righ

tth

roug

h in

tran

et e

mai

lth

at r

etur

ned

surv

ey s

uppo

rted

a

toba

cco-

free

pol

icy

for

the

four

build

ings

Stra

tegy

#2:

Pai

nt a

nd p

lace

art

wor

k in

sta

irw

ells

.R

espo

nsib

leC

omm

unic

atio

nD

ate

ofLo

ng-te

rm g

oal:

Impr

ove

appe

aran

ce o

f sta

irw

ells

so

Mem

ber(

s)to

Em

ploy

eeIm

plem

enta

tion

Res

ults

(O

utco

mes

)th

at e

mpl

oyee

s w

ill b

e m

otiv

ated

to

take

the

sta

irs

and

incr

ease

the

ir p

hysi

cal a

ctiv

ity

duri

ng t

he w

ork

day.

Step

#1—

Des

ign

plan

for

stai

rwel

l pai

nt c

olor

s an

d Jo

e B

lack

, Cha

ir;

Emai

l em

ploy

ees

wit

h 08

/01/

05C

heck

ed w

ith b

uild

ing

owne

rs a

nd

artw

ork

plac

emen

tB

ob C

allm

e an

d Su

sie

surv

ey a

bout

re

ceiv

ed o

kay

to p

aint

sta

irw

ells

C

ube

sugg

esti

ons

for

artw

ork,

an

d ha

ng a

rtw

ork;

Sus

ie C

ube

dona

tion

s, e

tc.

sent

em

ail t

o em

ploy

ees

aski

ng

for

dona

tion

s of

art

wor

k;

rece

ived

num

erou

s re

spon

ses

and

sugg

esti

ons;

com

mit

tee

vote

d to

dis

play

chi

ldre

n’s

artw

ork

of e

mpl

oyee

s; b

udge

t fo

r pa

int

and

fram

ing

esta

blis

hed;

pa

inti

ng b

udge

t w

as $

8000

and

fr

amin

g w

as $

2000

.


APPENDIX D: Worksite Wellness Committee Action Plan Sample, page 4St

ep #

2—M

eet

wit

h m

anag

emen

t to

dis

cuss

pla

nJo

e B

lack

N/A

10/0

1/05

Cha

ir m

et w

ith

mgt

. tea

m; n

o fu

nds

avai

labl

e fo

r pa

int

and

fram

ing

beca

use

dolla

rs h

ad

alre

ady

been

giv

en fo

r Sm

art

Step

s in

itia

tive

pos

ters

.

Step

#3—

Prep

are

impl

emen

tati

on p

lan

for

pain

ting

Jo

e B

lack

, Bob

Cal

lme,

01/0

1/06

At t

he r

egul

ar c

omm

ittee

mee

ting,

and

com

plet

ing

stai

rwel

l des

ign.

Susi

e C

ube

the

com

mit

tee

vote

d to

wor

k on

a

roll-

out

plan

for

pain

ting

and

fr

amin

g ar

twor

k; t

he n

ew im

ple-

men

tati

on p

lan

will

see

k al

tern

a-ti

ve fu

ndin

g so

urce

s; a

new

pla

n w

ill b

e sh

ared

at

the

May

06

com

mit

tee

mee

ting

.05

/01/

06C

omm

itte

e m

embe

rs r

epor

ted

that

the

new

impl

emen

tati

on

plan

will

incl

ude

usin

g vo

lunt

eers

fo

r pa

inti

ng, d

onat

ion

of p

aint

fr

om a

rea

pain

t st

ores

; don

atio

n of

pai

nt fr

om e

mpl

oyee

s; s

ever

al

empl

oyee

s ha

ve d

onat

ed t

ime

to

build

ing

the

fram

es n

eede

d fo

r th

e ar

twor

k. A

str

ateg

ic p

lan

will

be

rec

omm

ende

d fo

r ye

ar 2

and

th

e ti

mef

ram

e fo

r co

mpl

etin

g th

e pr

ojec

t w

ill b

e ex

tend

ed

over

a p

erio

d of

one

yea

r.

Year

-En

d E

valu

atio

n S

umm

ary:

Empl

oyee

Sat

isfa

ctio

n Su

rvey

: Of t

he 5

88 e

mpl

oyee

s th

at r

espo

nded

—38

% o

f the

em

ploy

ees

wer

e aw

are

of t

he w

orks

ite

wel

lnes

s pr

ogra

m a

nd 6

2% w

ere

awar

e of

the

wor

ksit

e w

elln

ess

com

mit

tee;

18%

had

par

tici

pate

d in

one

or

mor

e of

the

pro

gram

s of

fere

d; 7

5% o

f tho

se t

hat

part

icip

ated

rep

orte

d lif

esty

le c

hang

es a

s a

resu

lt; a

nd 6

5% o

f the

588

em

ploy

ees

repo

rted

tha

t th

ey w

ould

par

tici

pate

in fu

ture

pro

gram

s.

Polic

y &

Env

iron

men

tal S

urve

y (c

omm

itte

e on

ly):

The

com

mit

tee

focu

sed

on m

ovin

g th

e fo

ur w

orks

ites

wit

hin

the

divi

sion

tow

ards

a t

obac

co-fr

ee p

olic

y fo

r th

ein

side

of t

he b

uild

ings

. Cur

rent

ly, t

he b

uild

ings

are

not

tob

acco

free

. Thi

s w

as t

he fi

rst

prio

rity

for

the

com

mit

tee

in r

egar

ds t

o po

licy

chan

ge.

Rec

omm

end

atio

ns

from

th

e C

omm

itte

e fo

r Ye

ar #

___

1___

:

Succ

esse

s:

1) 4

6% o

f the

688

em

ploy

ees

that

ret

urne

d th

e su

rvey

con

cern

ing

toba

cco-

free

bui

ldin

gs is

a s

tron

g in

dica

tion

tha

t th

e co

mm

itte

e is

on

the

righ

t tr

ack

to p

ursu

epo

licy

in t

his

area

. Thi

s su

cces

s is

com

bine

d w

ith

the

“I Q

uit”

cam

paig

ns t

hat

we

held

thr

ough

out

the

year

and

com

bine

d w

ith

the

post

er c

ampa

ign

thro

ugho

utth

e bu

ildin

gs t

hat

rais

ed a

war

enes

s. T

he c

omm

itte

e fo

r ye

ar t

wo

is b

ette

r eq

uipp

ed t

o pu

rsue

pol

icy

chan

ge, a

s w

ell a

s se

ek a

nd b

ring

in o

ther

ces

sati

on p

ro-

gram

s. W

e fo

und

that

tho

se in

divi

dual

s th

at h

ad r

ecen

tly

quit

the

use

of t

obac

co w

ere

our

grea

test

cha

mpi

ons

and

enco

urag

ers!

2) T

he “

Smar

t St

eps”

init

iati

ve s

how

ed s

ome

succ

ess

and

appe

ared

to

be a

nic

e fit

wit

h th

e he

alth

y lu

nch

mee

ting

s. T

here

wer

e nu

mer

ous

oppo

rtun

itie

s du

ring

thes

e m

eeti

ngs

to s

hare

han

dout

s an

d ta

lk a

bout

hea

lthy

eat

ing,

as

wel

l as

way

s to

incr

ease

phy

sica

l act

ivit

y. T

he m

ost

succ

essf

ul a

ctiv

ity

was

the

mys

tery

post

er c

onte

st! I

t ap

pear

s th

at t

he “

scav

enge

r hu

nt”

men

talit

y is

a g

ood

tool

and

it a

ctua

lly fo

rced

em

ploy

ees

to t

ake

step

s to

find

the

pos

ters

!



Less

ons

Lear

ned

and/

or B

arri

ers:

1) O

ur g

reat

est

chal

leng

e w

as fi

ndin

g th

e fu

nds

to d

o th

e nu

mer

ous

acti

viti

es. I

niti

ally

, we

bega

n w

ith

the

Smar

t St

eps

post

ers

and

man

agem

ent

was

abl

e to

fund

thos

e. B

ut, l

esso

n le

arne

d w

as t

hat

we

need

to

bett

er e

valu

ate

our

over

all p

rogr

am, d

eter

min

e ho

w m

uch

fund

ing

is a

vaila

ble

(if a

ny)

and

whi

ch p

rogr

am w

illpr

ovid

e th

e m

ost

bene

fit a

nd b

ang

for

the

buck

! We

also

rea

lized

tha

t w

e m

ay h

ave

to d

epen

d on

our

em

ploy

ees

to c

ontr

ibut

e, n

ot n

eces

sari

ly m

onet

arily

, but

to

be w

illin

g to

hel

p us

find

oth

er a

venu

es o

f sup

port

.

2) A

noth

er e

xam

ple

of t

he a

bove

was

the

des

ign

plan

for

pain

ting

and

pla

cing

art

wor

k in

the

sta

irw

ells

of a

ll fo

ur b

uild

ings

. The

exp

ense

was

hug

e, s

o it

forc

ed t

heco

mm

itte

e ba

ck t

o th

e dr

awin

g ta

ble

to lo

ok fo

r ot

her

alte

rnat

ives

.

3) O

bvio

usly

, fro

m t

he r

esul

ts o

f the

Em

ploy

ee S

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Date ______________________

Dear ______________________,

(Name of worksite) has received training on how to use the North Carolina HealthSmart WorksiteWellness Toolkit. This toolkit has resources to help us improve the health of employees at ourworkplace as well as resources that individuals can use to make healthier lifestyle choices, suchas eating healthy, increasing physical activity, quitting the use of tobacco and reducing stress.

The toolkit developed by the NC State Health Plan and the NC Division of Public Health, includesa workbook for establishing a Worksite Wellness Committee and four (4) resource workbooks—Eat Smart, Move More, Quit Now and Manage Stress. Our goal is to have a committee that repre-sents our unique worksite and establishes an action plan for how we might use the toolkit mosteffectively.

You are invited to serve on the Worksite Wellness Committee. The committee will meet on (insertdate, time and location). Please check with your immediate supervisor to confirm that your par-ticipation and responsibility to the Worksite Wellness Committee is approved and will be reflect-ed in your annual work plan. I am available to explain to your supervisor the nature of the com-mittee and general time commitments.

The major responsibilities of the Worksite Wellness Committee would include but would not belimited to: communicating the wellness program to employees at our worksite, advocating forpolicies that support health, promoting participation in wellness activities, managing the activi-ties and evaluating the impact of the wellness program.

If you cannot serve on the Committee at this time, please notify me as soon as possible.

Sincerely,

(Signature—Supervisor/Manager)


APPENDIX E: Sample Letter of Invitation to Serve on the Worksite Wellness Committee

Brought to you by the State Health Plan

APPENDIX F: Worksite Wellness Committee Invitation Poster


CWCommitteePoster.pdf

WORKSITE WELLNESS COMMITTEE MEMBERS

Name of Worksite_______________________________________________________________________________

Member Name Supervisor Approval Workplan Revision

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.


APPENDIX G: Worksite Wellness Committee Members

NC HEALTHSMART WORKSITE WELLNESS COMMITTEE MEETING

Worksite Name: ___________________________________________________

Date: __________________________ Time:_____________________________

AGENDA

Call meeting to order

Introductions—Committee MembersShare your name, department, favorite food and one favorite physical activitySign Committee Communication list—name, email address and phone number

Orientation to NC HealthSmart Worksite Wellness ToolkitMulti-Level Approach to Change (Appendix A)NC HealthSmart Program Overview (Appendix B)Overview of the five (5) workbooks (Appendix L)

Worksite Wellness CommitteeEat SmartMove MoreQuit NowManage Stress

Committee Name

Mission Statement

Committee Chairperson and Program Coordinator Selection

Employee Communication Plan

Overview of Action Plan and SurveysWorksite Wellness Committee Action Plan (Appendix C)Worksite Wellness Committee Action Plan Sample (Appendix D)Employee Interest Survey (Appendix I)Policy and Environment Survey (Appendix J)

Schedule Future Meetings

Adjourn

APPENDIX H: First Meeting—Sample Agenda



NC HEALTHSMART WORKSITE WELLNESS

Employee Interest Survey

Directions: Indicate your interest for each of the following by circling:1: little or no interest 2: some interest 3: very interested

I am interested in:

1. learning more about healthy food choices. 1 2 3

2. learning how to incorporate fruits and vegetables into my diet. 1 2 3

3. learning about healthier food choices and portions to help manage 1 2 3my weight.

4. participating in “tasting” events to sample healthy foods. 1 2 3

5. having healthy snacks available for purchase at work. 1 2 3

6. learning more about the benefits of physical activity 1 2 3 and how it can influence my health.

7. increasing my physical activity level. 1 2 3

8. walking to increase physical activity. 1 2 3

9. participating in team activities. 1 2 3

10. learning ways to cope with feelings of stress. 1 2 3

11. time management skills. 1 2 3

12. improving my communication skills. 1 2 3

13. learning skills to cope with change. 1 2 3

14. organized social events with my co-workers. 1 2 3Events might be holiday party or summer picnic.

15. participating in wellness activities within my regular work schedule. 1 2 3

16. participating in wellness activities before work 1 2 3

17. participating in wellness activities after work. 1 2 3

18. 10-15 minute activities that I can do two to three times a day. 1 2 3

19. activities that last 30–60 minutes. 1 2 3

20. health information that I can read, listen to, or watch 1 2 3on my own.

21. participating with a group to learn more about wellness. 1 2 3

Continued

APPENDIX I: Employee Interest Survey, page 1

APPENDIX I: Employee Interest Survey, page 2


Directions: Indicate your interest for each of the following by circling:1: little or no interest 2: some interest 3: very interested

I am interested in:

22. working in a tobacco-free environment. 1 2 3

23. working with others to reduce second-hand smoke 1 2 3in my workplace.

Please complete questions 24–27 only if you currently use tobacco.

24. getting information about quitting tobacco use. 1 2 3

25. attending information sessions or classes about quitting 1 2 3tobacco use.

26. using my meal break time to learn about quitting the use 1 2 3of tobacco.

27. using time before or after work to learn about quitting the 1 2 3use of tobacco.

Please return this survey to:____________________________________________

By this date:____________________________________________


NC HEALTHSMART WORKSITE WELLNESS

Policy & Environment Survey

Directions: • This survey is completed by the worksite wellness committee members only. • Please circle your answer to each of the questions. • Choose N/A on any question that does not apply to your worksite.

1. Does your worksite have any written policy or policies recommending Yes No Not Sure N/Athe use of healthier foods for holiday celebrations or staff meetings?

2. If Yes, are employees told about the healthy foods policy or policies Yes No Not Sure N/Aduring orientation?

3. Does your worksite have a refrigerator designated for food for Yes No Not Sure N/Aemployees to use?

4. Does your worksite have any equipment and sink access available Yes No Not Sure N/Afor employees to use to prepare and eat meals?

5. Does your worksite have any vending machines? Yes No Not Sure N/A

6. If Yes, do the vending machine(s) offer at least 5 healthy choices? Yes No Not Sure N/AHealthy choices include fresh fruits, whole grain chips, or baked chips, etc.

7. Does your worksite have a cafeteria? Yes No Not Sure N/A

8. If Yes, Does your cafeteria offer at least 5 healthy choices like 100% Yes No Not Sure N/Ajuice products, fresh fruits, or whole grain products?

9. Has information on healthy food choices been provided to employees Yes No Not Sure N/Ain the past year?

How? _______________________________________________________

10. Does your worksite have any written policy or policies encouraging Yes No Not Sure N/Aphysical activity during the workday?

11. Does your worksite have stairs? Yes No Not Sure N/A

12. If yes, are the stairs safe, clean and well-lit? Yes No Not Sure N/A

13. Does your worksite have a safe place for walking or other activities Yes No Not Sure N/Aon-site or near-by?

Name of near-by facility ______________________________________

14. Does your worksite sponsor any physical activities, teams or clubs? Yes No Not Sure N/A

Name of activity:_____________________________________________

15. Does your worksite sponsor any community-based activities, teams Yes No Not Sure N/Aor clubs?

Name of activity: _____________________________________________

Continued

APPENDIX J: Policy and Environment Survey, page 1

APPENDIX J: Policy and Environment Survey, page 2


16. Has information on physical activity been provided to employees Yes No Not Sure N/Ain the past year?

How provided? ______________________________________________

17. Does your worksite have any written policy or policies supporting Yes No Not Sure N/Aand encouraging communication that is open, two-way and respectful of employee diversity?

18. Does your worksite have any place for employees to reduce the Yes No Not Sure N/Aphysical and mental stress of the workday?

19. Has any activity or activities been provided for dealing with Yes No Not Sure N/Asignificant changes in the worksite in the past 2 years? A significant change may be a change in management, high staff turnover or loss, or changes in work conditions?

What was done? _____________________________________________

20. Has any program(s) or material(s) for managing stress been provided Yes No Not Sure N/Aat your worksite in the past year? This might be a class for supervisors, relaxation, communication, or time management.

What was provided? ______________________________________________

21. Does your worksite have any written policy or policies that prohibit Yes No Not Sure N/Aor restrict smoking at the worksite?

21a. If Yes, is smoking permitted outside on worksite grounds? Yes No Not Sure N/A

21b.If Yes, is smoking permitted anywhere in worksite buildings? Yes No Not Sure N/A

22. If Yes to 21 a or b, are signs posted for smoking or non-smoking areas? Yes No Not Sure N/A

23. Are tobacco vending machines or vendors restricted or prohibited Yes No Not Sure N/Aat the worksite?

24. Has any information on health effects of tobacco been provided to Yes No Not Sure N/Aemployees in the past year?

How? _______________________________________________________

25. Have smoking or tobacco cessation programs been offered on-site Yes No Not Sure N/Aduring the last year?

What? ______________________________________________________

Please return this survey to:____________________________________________

By this date:____________________________________________


APPENDIX K: Meeting Physical Activity Breaks, page 1

APPENDIX K: Meeting Physical Activity Breaks, page 2



APPENDIX L: NC HealthSmart Workbook Overviews, page 1

THE NC HEALTHSMART WORKSITE WELLNESSTOOLKIT is an all-in-one resource for establishinga worksite wellness program for employees thatpromotes and supports eating healthy, increasingphysical activity, quitting the use of tobacco andreducing stress.

It is designed for employees to create wellnesscommittees that promote individual behaviorchange, as well as policy and environmentalchanges that support good health for all employees.

The toolkit is organized into five workbooks:1. Worksite Wellness Committee Workbook2. Eat Smart3. Move More4. Quit Now5. Manage StressEach of the workbooks, described below, is a

comprehensive collection of ready-to-use programmaterials for promoting worksite wellness.

WORKSITE WELLNESS COMMITTEE WORKBOOKThe key to a successful worksite wellness program is the estab-lishment of an organized and productive worksite wellness com-mittee. This workbook outlines the step-by-step process forestablishing and maintaining a wellness committee, defines com-mittee responsibilities and provides ready-to-use meeting agen-das, worksite surveys, action plan, program evaluation tools andother resources.

The remaining four (4) resource workbooks each include the fol-lowing sections:

• HealthStart Activity—an activity that includes ready-to-usematerials, such as announcements, posters, handouts, etc.This activity focuses on individual behavior change and canbe used to “jumpstart” worksite wellness committees’ efforts and pro-gram activities that help achieve short-term success for your wellnessprogram.

• Resources for Individuals and Groups• Resources for Worksite Policies• Resources for Worksite Environments• Other Resources

A brief description of each resource workbook follows.

What is the NC HealthSmart WorksiteWellness Toolkit?



EAT SMART The food we eat directly and indirectly affects our physical andmental well-being. It is the fuel that keeps our bodies going. Ahealthy eating pattern can help to prevent several chronic dis-eases and conditions including heart disease, stroke, some can-cers, diabetes, high blood pressure, arthritis, osteoporosis anddepression. Furthermore, a balanced diet combined with ade-quate physical activity helps to achieve energy balance and is themost important factor in maintaining a desirable body weight.

The Eat Smart workbook offers a wide range of resources forindividual/group activities, as well as policy and environmentalchanges that encourage all employees to eat healthy. The appen-dices provide ready-to-use sample policies, posters, signs, let-ters, one-page handouts, healthy foods lists, recipes, etc.

MOVE MOREPhysical activity helps to enhance the quality of life for people of allages and abilities. Sedentary individuals can substantially reduce therisk of developing heart disease, diabetes, osteoporosis and coloncancer just by becoming moderately physically active on most daysof the week.

A physically active lifestyle can help to reduce the risk of develop-ing heart disease, diabetes and certain cancers. It also reduces heartdisease risk factors such as high cholesterol, hypertension and over-weight as well as protect against stroke. It helps to build a healthierbody by strengthening bones, muscles and joints; aids in reducingdepression and anxiety, enhances the response of the immune sys-tem, reduces falls among older adults and is associated with fewerhospitalizations, physician visits, and medications. Moreover, phys-ical activity need not be strenuous to be beneficial; people of all agescan benefit from participating in regular, moderate-intensityphysical activity, such as 30 minutes of brisk walking on mostdays of the week.

The workbook offers a wide range of resources for individ-ual/group activities, as well as policy and environmentalchanges that encourage all employees to Move More. Theappendices provide ready-to-use sample policies, posters,signs, letters, one-page handouts, questionnaires, sign-insheets, pledge card, walking log, etc.

QUIT NOWTobacco use is the number one preventable cause of death inthe United States. Tobacco use in any form is not only harmfulfor the person using the product but also for non-smokers andother people in the environment.



Some of the proven health consequences of tobacco use include prema-ture death, disability and disease including heart disease, stoke, severalcancers, chronic bronchitis and emphysema. Tobacco use is also a cause

of intrauterine growth retardation leading to lowbirth weight babies and a probable cause of unsuc-cessful pregnancies.

In view of the above mentioned health hazards,and that tobacco use can lead to nicotine addition,it makes common sense to quit tobacco use.However, it is also true that once addicted to nico-tine it is not easy to quit tobacco use. Since employ-ees spend a lot of time at their work, worksites canhelp interested employees to quit tobacco use bytaking steps to make the worksite tobacco free. Atobacco free policy/environment at the worksite canbe a huge incentive to help employees quit.

The workbook offers a wide range of resourcesfor individual/group activities, as well as policy and

environmental changes that encourage all employees to Quit Now. Theappendices provide ready-to-use sample policies, posters, signs, letters,one-page handouts, worksite surveys, success stories, pledge card, listingof free resources, etc.

MANAGE STRESSThe worksite wellness committee can initiate programs andactivities to help employees manage their stress and gain skillsto manage the demands of the work environment. Stress is a nat-urally occurring reaction of your body to psychological or phys-ical demands of the environment. Stress reaction increasesblood pressure, heart rate and respiration as well as otherchanges to major body systems. These reactions prepare thebody for “fight or flight” from physically dangerous or psycho-logically threatening situations. The causes of stress reaction inthe workplace include task demands, time demands, physicaldemands, role demands and interpersonal demands.

The workbook offers a wide range of resources for individual/group activities, as well as policy and environmental changes thatsupport employees’ efforts to manage stress. The appendicesprovide ready-to-use Manage Stress group activities, sampleposters, signs, one-page handouts, listing of free resources, etc.

The entire con-tents of the NCHealthSmartWorksite Wellness

Toolkit includingall the workbooks

and appendices are included in the CDprovided with the Toolkit. Please feelfree to make copies of this CD and shareamong the worksite wellness committeemembers.

Sample Mission Statements

The mission statement should be a global expression of what the Worksite Wellness Committee wants toaccomplish using the NC HealthSmart Worksite Wellness Toolkit. The mission statement may include adescription of the value of the program to the worksite and to its employees. You may decide on a mis-sion statement that reflects the work the committee wants to accomplish. You may choose to select onefrom these or create your own.

Examples:

“The mission of the (name of worksite) Worksite Wellness Committee is to establish and main-tain a worksite that encourages environmental and social support for a healthy lifestyle.”

“To encourage employees’ personal and professional productivity, and physical and mental well-being, the mission of the (name of worksite) Worksite Wellness Committee shall be to promotea worksite culture that supports employees’ desire to make healthy lifestyle choices.”

“Because employees spend 40 hours a week at work, it is important that the worksite be a healthyplace to work and support healthy choices for employees. It is the mission of the (name of work-site) Worksite Wellness Committee to work toward implementing policies that support a healthyworksite and healthy employees.”

“The worksite wellness committee will work to provide opportunities for employees to develophealthier lifestyles by supporting the adoption of habits and attitudes that contribute to their pos-itive well-being.”

APPENDIX M: Sample Mission Statements


Committee Members and Role Sharing

Worksite Wellness Committees can operate efficiently and avoid burn-out if members of the committeeshare responsibilities. Some of the roles that can be shared on a worksite wellness committee include:

Committee Chairperson: This position can be shared by two employees as co-chairpersons. The dutiesand responsibilities for one may be to handle the administration and communication needs of the com-mittee. The other co-chair might be responsible for the overall program activities of the committee.

Program Coordinator(s): The number of pro-gram coordinators that the committee has isusually dictated by the number of programsand/or activities that are outlined in the actionplan. By assigning a program coordinator toeach activity that you implement at yourworksite, you do not place the burden of allprograms on one employee.


APPENDIX N: Committee Members and Role Sharing

The important thing to remember is to share theresponsibility among committee members andrecruit employees who are not on the committeeas well to serve on sub-committees. Other chair-persons that can be assigned and shared include:

Communications ChairEmployee Interest Survey ChairEvent Planner ChairManagement Liaison ChairAction Plan Chair

APPENDIX O: Worksite Wellness Committee Announcement


CWComAnnouncePoster.pdf

Dear Co-Workers,

In today’s fast paced world where most of our lifestyle choices are influenced by convenience andtechnology, chronic health conditions/diseases have begun to rise at an alarming rate.

Also, most of the focus and expense of the healthcare industry has been for the treatment ofchronic diseases. By focusing on prevention, several chronic diseases can be prevented or madeless serious. Our employers can play a crucial role in helping us make healthier lifestyle choicesthat can lead to a more enjoyable life for all of us.

As some of us are aware, our worksite has received the NC HealthSmart Worksite Wellness Toolkit.A worksite wellness committee has also been established to make our worksite a healthier work-place and promote the health of our employees. The toolkit will provide resources and materialsto help the worksite wellness committee achieve its goals.

However, before the wellness committee can put the toolkit resources to effective use and initiatewellness activities/programs at the worksite, it is imperative to learn about the interests of ouremployees. The success of any worksite wellness initiative will ultimately depend on what theemployees want and will participate in. Attached is a short Employee Interest Survey that werequest you to complete and return to the committee member specified below.

Please complete the attached survey. You do not have to sign your name.

Return your completed survey to ______________________________________ by ___________________.

Working together, Our employees can have better

HEALTH and be Smart.

Thank you!

Worksite Wellness Committee

______________________________________________________________(name of worksite)


APPENDIX P: Cover Letter for Employee Interest Survey

Brought to you by the State Health Plan

APPENDIX Q: Employee Interest Survey Distribution and Collection Suggestions


Distribution Method

Pros Cons Additional Information

PersonalDistribution

Low cost. Personalcontact with employ-ees might increase thenumber of surveyresponses. Personalinteraction will allowwellness members totalk about the impor-tance of completingthe Employee InterestSurvey.

Could involve a significant time involve-ment for large worksites. In facilities withdifferent shifts of employee work-time,committee members would need to coverall shifts to ensure distribution to allemployees. Home-based employees mightnot receive surveys. Employees might bedisbursed throughout several worksites.Could involve a high level of committeeinvolvement in counting and monitoringsurvey responses in large offices.

Personal distribution could be combinedwith mailbox, paycheck stuffers, or emaildistribution to include employees at allshifts and locations (this would involve sig-nificant committee involvement in identify-ing employees who are home-based or worknight-time shifts). In smaller offices, surveyscould be distributed and completed in staffmeetings, ensuring high levels of surveyresponses.

Mailboxstuffers

Low cost. Surveys canbe distributed withrelative ease.

Some employees might not check theirmailboxes. Could involve making highnumbers of copies in large offices. Couldinvolve a high level of committee involve-ment in counting and monitoring surveyresponses in large offices.

Be sure to specify a specific survey collec-tion spot for employees to drop surveys.

Paycheckstuffers,Memoaddendums

Low cost. Surveys canbe distributed withrelative ease. Mostemployees will receive(and open) paychecksand employee memos.

Could involve making high numbers ofcopies in large offices. Method does notinclude temporary staff. Could involve ahigh level of committee involvement incounting and monitoring survey respons-es in large offices.

Be sure to specify a specific survey collec-tion spot for employees to drop surveys.

Email distribution

No cost. Surveys canbe distributed veryeasily.

Employees might not respond to email.Method does not include employees with-out email. Could involve a high level ofcommittee involvement in counting andmonitoring survey responses in largeoffices.

Email distribution could be combined withmailbox stuffers or paycheck stuffers toinclude temporary and non-email staff (this would involve significant committeeinvolvement in identifying employees without computers).

OnlineSurveys

Surveys could be easily distributed viaemail. Low level ofcommittee involve-ment needed in tabu-lating survey results—the survey websitewill collect and scoredata. Very easy tomonitor the numberof survey responses.

Significant cost involved. Method does notinclude employees without internetaccess. Committee involvement needed insetting up survey online.

Email notification of online survey sitecould be combined with mailbox stuffers or paycheck stuffers to include employeeswithout access to the internet (this wouldinvolve significant committee involvementin identifying employees without comput-ers). The following websites offer onlinesurveys:www.zommerang.com www.surveymonkey.com

**Some things to keep in mind while distributing surveys:

1. Your wellness committee should consider setting a target date for receiving survey responses. Having a set date to return surveyswill make some employees more likely to complete them.

2. Consider having a drawing or incentives for employees who complete their surveys. These incentives or drawings do not have tocost money! For example, your committee could: offer relief from shared office tasks (like cleaning common areas or contributingto the coffee fund) to the first 5 employees who finish their surveys; find a local business to donate a gift card to give to drawingwinners; post a “thank you” note to employees who complete their surveys in a visible notice board. (This could be done a weekor a few days before the final collection date to remind others to complete their surveys.)

3. Think about posting fliers or sending out reminder emails to keep employees informed about the importance of the EmployeeInterest Survey. Remember: a few well placed fliers and a small number of emails will keep people’s attention. Try not to floodemployees’ mailboxes with too many emails or they will begin to delete them.

4. Remind Wellness Committee members to talk up the surveys! Committee members are your greatest assets and biggest champi-ons. Members can make short presentations in management or office staff meetings about the importance of the survey and thefinal collection date. Also, ask them to talk about the importance of the Employee Interest Survey to their friends and co-workers.News will spread, generating greater survey participation.

Ideas for Distributing Employee Interest Surveys


APPENDIX R: Second Meeting—Sample Agenda

NC HEALTHSMART WORKSITE WELLNESS COMMITTEE MEETING

Worksite Name: ___________________________________________________

Date: __________________________ Time:_____________________________

AGENDA

Call meeting to order

Old Business

Employee Interest SurveyEstablish plan for distribution and collection of surveys

Worksite Policy and Environment Survey Report Report the results of the surveyEstablish long-term goals (strategies and steps) for policyand/or environmental changes at the worksiteSelect resources from the four (4) workbooks

Management IssuesFunding for incentives and materialsWorksite policies regarding wellness activities

Strategies for Communicating with Management

Review Schedule of Future Meetings

Adjourn

Employee Interest Survey Score Sheet

Name of Worksite __________________________________________________Total Number of Surveys Distributed _________________Total Number of Surveys Returned ___________________

Directions1. Collect all completed Employee Interest Surveys.2. For each question, add the response number that has been circled on all surveys. This will give you the

final score for each one of the questions from 1 to 27.3. For example, if you collect 3 completed surveys and the responses for Question 1 on these surveys are:

3, 2 and 3, then the score for Question 1 is 3+2+3 = 8.

EAT SMART

1. I am interested in learning more about healthy food choices.

2. I am interested in learning how to incorporate fruits and vegetables into my diet.

3. I am interested in learning about healthier food choices and portions to help manage my weight.

4. I am interested in participating in “tasting” events to sample healthy foods.

5. I am interested in having healthy snacks available for purchase at work.

MOVE MORE

6. I am interested in learning more about the benefits of physical activity.

7. I am interested in increasing my physical activity level.

8. I am interested in walking to increase physical activity.

9. I am interested in participating in team activities.

MANAGE STRESS

10. I am interested in learning ways to cope with feelings of stress.

11. I am interested in time management skills.

12. I am interested in improving my communication skills.

13. I am interested in learning skills to cope with change.

14. I am interested in organized social events with my co-workers. Events might be holiday party or summer picnic.

WHEN EMPLOYEES WOULD MOST LIKELY PARTICIPATE IN PROGRAMS

15. I am interested in participating in wellness activities within my regular work schedule.

16. I am interested in participating in wellness activities before work.

17. I am interested in participating in wellness activities after work.

APPENDIX S: Score Sheet for Employee Interest Survey, page 1



APPENDIX S: Score Sheet for Employee Interest Survey, page 2

HOW LONG EMPLOYEES WANT PROGRAMS TO LAST.

18. I am interested in 10-15 minute activities that I can do two to three times a day.

19. I am interested in activities that last 30-60 minutes.

INDIVIDUAL OR GROUP ACTIVITIES

20. I am interested in health information that I can read, listen to, or watch on my own.

21. I am interested in participating with a group to learn more about wellness.

SMOKEFREE WORKPLACE

22. I am interested in working in a tobacco-free environment.

23. I am interested in working with others to reduce second-hand smoke in my workplace.

QUIT NOW

Tobacco Users. How many surveys had these questions completed?

24. I am interested in getting information about quitting tobacco use.

25. I am interested in attending information sessions or classes about quitting tobacco use.

26. I am interested in using my meal break time to learn about quitting the use of tobacco.

27. I am interested in using time before work or after work to learn about quitting the use of tobacco.

High scores indicate higher employee interest in that particular area. Suggestions and ready-to-useresources for individual and group activities in each of the four areas are provided in the respectiveworkbooks of the toolkit.

Score Sheet for Policy and EnvironmentSurvey

Name of Worksite ___________________________________Number of Completed Surveys _______________________

Count the total number of “NO” answers for questions 1–9for all surveys completed by the committee members.

This is the EAT SMART score Out of possible score = 9


This is the MOVE MORE score Out of possible score = 6


This is the MANAGE STRESS score Out of possible score = 4


This is the QUIT NOW score Out of possible score = 5

Look at the scores for all the four policy/environmental areas. High numbers indicate areas where policyand environmental changes are needed the most to make your workplace a healthier one.

Suggestions and ready-to-use resources for worksite policy and environmental changes in each of the fourareas are provided in the respective workbooks of the toolkit.

APPENDIX T: Score Sheet for Policy & Environment Survey


Employee Evaluation of a Worksite Activity

You recently participated in __________________________________________, a Worksite Wellness Programactivity provided by the Wellness Committee at your worksite.

Please complete this evaluation form in order to help the Wellness Committee create the best possiblewellness programs/activities at our worksite. Thank You!

Please indicate your level of agreement using this scale:1=Strongly disagree 2= Disagree 3=Agree 4=Strongly agree NS=not sure

1. This activity has influenced me to make healthier lifestyle choices. 1 2 3 4 NS

2. I would like to participate in similar activities in the future. 1 2 3 4 NS

3. I would recommend this activity to my co-workers. 1 2 3 4 NS

The best/most helpful part of this activity was_____________________________________________________

_______________________________________________________________________________________________

This activity could be improved by:_______________________________________________________________

_______________________________________________________________________________________________

4. Please check any areas that you would like for wellness programs to be provided:

nn Healthy Eating nn Quit Tobacco Use

nn Physical Activity nn Stress Management

Please return this form to:

_____________________________________

_____________________________________


APPENDIX U: Employee Evaluation of a Worksite Activity

Employee Satisfaction with Worksite Wellness Program

Name of Worksite: __________________________________________________ Date: _____________________

1. Are you aware of the Worksite Wellness Program that has been Yes Noestablished at your worksite?

2. Are you interested in receiving additional information concerning Yes Nothe Worksite Wellness Program?

3. Have you participated in any wellness activity(ies) conducted at your worksite? Yes No

4a. Have you made healthier lifestyle choices since the Worksite Wellness Program Yes Nowas established at your worksite?

4b. If Yes, check areas where you have made healthier lifestyle choices (check all that apply).

nn Eating healthier nn Quit tobacco use

nn Increased physical activity nn Reduced stress level

5. Would you like to participate in future wellness activities at your worksite? Yes No

6. What improvements to the Worksite Wellness Program would you like to see?

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Your input helps us make improvements to your Worksite Wellness Program. By completing this survey,you help us to provide the best wellness programming and activities at our worksite. Thank you!

Please return to (contact person for Worksite Wellness Program):

___________________________________________________

___________________________________________________

Return by (date):___________________________________

If you would like information from the Wellness Committee at your worksite, either contact the personnamed above, or enter your name and contact information below.

___________________________________________________

___________________________________________________

APPENDIX V: Employee Satisfaction with Worksite Wellness Program


Employee Satisfaction Survey Results Form

Name of Worksite: _____________________________________________________

Report Prepared by: ___________________________________________________

Number of Surveys distributed: ____________

Number of Surveys returned: ____________

Percent (%) of employees aware of the worksite wellness program ________________

Percent (%) of employees aware of the worksite wellness committee ________________

Percent (%) of employees who participated in worksite wellness activities ________________

Percent (%) of employees who reported lifestyle changes occurred due to ________________worksite wellness program activities

Percent (%) of employees who would like to participate in future worksite ________________wellness program activities


APPENDIX W: Employee Satisfaction Survey Results Form

Evaluation of Wellness Committee by Committee Members

This questionnaire is designed to help your committee assess your Worksite Wellness Program and thecommittee’s strengths and weaknesses. It is for your use only to guide your discussions of how wellthe committee functions and how the wellness program could be improved. Feel free to add otherquestions that you think would help this effort.

1. Are all areas of your worksite represented on your committee? Yes No

1a. How could representation be improved?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

2. Is management represented on your committee? Yes No

3a. In what ways has management been supportive of your efforts?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

3b. In what ways would you like management to be more supportive?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

4. Has the committee completed a written action plan? Yes No

4a. Does the action plan include at least one short-term and one Yes Nolong-term objective?

4b. Have you implemented any activities from your action plan? Yes No

4c. Which behavior(s) does your action plan focus on?

nn Healthy Eating nn Quit Tobacco Use

nn Physical Activity nn Stress Management

5. What would help your committee do a better job of working together?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

6. In what ways is the wellness program helping employees?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

7. What could the committee do to make the program more effective?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

APPENDIX X: Evaluation of Wellness Committee by Committee Members


NC HealthSmart Worksite Wellness Toolkit Evaluation Form

Please rate the usefulness of the toolkit using the following scale:1 = Strongly Disagree 2= Somewhat Disagree 3= Agree 4= Strongly Agree

1. The overall worksite wellness program objectives were clearly 1 2 3 4explained and were incorporated throughout the toolkit.

2. The committee workbook was a helpful guide for establishing a 1 2 3 4worksite wellness committee.

Please rate the helpfulness of the workbooks using the following scale:1 = Strongly Disagree 2= Somewhat Disagree 3= Agree 4= Strongly Agree NA=Not used

3a. The Eat Smart workbook was a helpful resource 1 2 3 4 NA

3b. The Move More workbook was a helpful resource 1 2 3 4 NA

3c. The Quit Now workbook was a helpful resource 1 2 3 4 NA

3d. The Eat Smart workbook was a helpful resource 1 2 3 4 NA

3e. What would make the workbook(s) you rated more helpful?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

4a. To what extent do you think the overall Worksite Wellness Toolkit provides guidance for estab-lishing and maintaining a worksite wellness committee?

nn 1—Not well at all nn 2—Somewhat nn 3—Very well

4b. What changes would make the Worksite Wellness Toolkit more useful?

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

Please return this survey to:State Health PlanAttn: Worksite Wellness4509 Creedmoor Road, Suite 201Raleigh, NC 27612-3813


APPENDIX Y: NC HealthSmart Worksite Wellness Toolkit Evaluation Form

Documents

COMMITTEE WORKBOOK