Form Approved OMB No: 0920-0445 Expiration Date: 10/31/2002 Faculty and Staff Health Promotion State Questionnaire Faculty and Staff Health Promotion State Questionnaire Questions Wellness Workshops and Employee Assistance Programs 1 - 2 Other Health Promotion Activities and Services 3 - 6 Activities and Services Coordination 7 - 9 Required Examinations and Screenings 10 - 15 Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, Mailstop D-24, Atlanta, GA 30333; Attention PRA (0920-0445). Special Instructions 1. This questionnaire focuses on your state practices and policies. 2. When we use the word “policy,” we mean any mandate issued by the state school board, state legislature, or other state agency that affects faculty and staff health promotion in districts or schools throughout your state. Please consider any policies officially adopted at the state level. These include policies developed by your state, or those based on model policies developed elsewhere. 3. We recognize that there may be some exceptions to the policies, but please answer the questions based on what is customary in your state. Please do not consider district or school practices or policies when answering the questions. (We will ask about district and school practices and policies when we collect information from districts and schools across the country.) 4. Please include activities or services offered by your state, districts, schools, or by anyone outside the school system. However, please consider only those activities or services that are offered to faculty and staff because they work at schools in your state. 5. Do not include those activities or services that faculty and staff receive through their personal employee health plans or insurance programs. 6. If you would like more information about this study or would like clarification of any questions in this survey, please call Tim Smith at 1-800-647-9664, extension 6095. Wellness Workshops and Employee Assistance Programs 1. Has your state adopted a policy stating that districts or schools will provide any funding for or sponsor “wellness workshops?” By “wellness workshops,” we mean seminars, classes, or other activities focusing on ways to improve or maintain physical health or overall well-being. Yes 1 No 2 2. Has your state adopted a policy stating that districts or schools will provide any funding for or sponsor an Employee Assistance Program (EAP) for school faculty and staff? EAPs provide services designed to assist employees experiencing personal or social problems that can impact work performance, physical health, or overall well-being. Yes 1 No 2 Other Health Promotion Activities and Services 3. Has your state adopted a policy stating that districts or schools will provide any funding for or sponsor the following screenings for school faculty and staff? Yes No a. Hearing problems 1 2 b. Vision problems 1 2 c. Oral health problems 1 2 d. Tuberculosis (TB) 1 2 e. Height and weight or body mass 1 2 f. Serum cholesterol level 1 2 g. Blood pressure level 1 2 h. Diabetes 1 2 i. Skin cancer 1 2 j. Breast cancer 1 2 k. Colorectal cancer 1 2 4. Has your state adopted a policy stating that districts or schools will provide any funding for or sponsor each of the following services or programs for school faculty and staff? Yes No a. Alcohol or other drug use treatment 1 2 b. Tobacco use cessation 1 2 c. Nutrition and dietary behavior counseling 1 2 d. Weight management 1 2 e. Physical activity and fitness counseling 1 2 f. Stress management 1 2 g. Identification of or counseling for mental or emotional disorders, such as anxiety or depression 1 2 h. Identification of or referral for physical, sexual, or emotional abuse 1 2 i. Crisis intervention for personal problems 1 2 j. Human immunodeficiency virus (HIV) testing and counseling 1 2 k. Referrals for child care 1 2 l. Identification of or referral for dental problems 1 2 m. Prenatal education 1 2 n. Identification or treatment of sexually transmitted diseases (STDs) 1 2 5. Has your state adopted a policy stating that districts or schools will provide any funding for or sponsor any physical activity programs for school faculty and staff, such as aerobics classes, basketball leagues, or walking or jogging clubs? Yes 1 No 2 6. Has your state adopted a policy stating that indoor or outdoor school facilities or equipment that could be used for physical activity will be made available for school faculty and staff to use? Please include any school facilities or equipment such as gyms, cafeterias, swimming pools, weight-lifting equipment, and cardiovascular exercise equipment. Yes 1 No 2 Activities and Services Coordination 7. Does someone in the state education or health agency oversee or coordinate health promotion activities or services for school faculty and staff throughout the state? Faculty and staff health promotion activities or services focus on prevention of physical illnesses or injuries, promotion of physical fitness, promotion of mental health, or other activities or services designed to assist school faculty and staff experiencing problems that can impact job performance, physical health, or overall well-being. Yes 1 No 2 8. Has your state adopted a policy stating that districts will have someone to oversee or coordinate health promotion activities or services for school faculty and staff throughout the district? Yes 1 No 2 9. Has your state adopted a policy stating that each school will have someone to oversee or coordinate health promotion activities or services for their faculty and staff? Yes 1 No 2 Required Examinations and Screenings 10. Next, we would like to ask about policies your state has adopted on health examinations and screenings that school faculty and staff are required to receive prior to employment. Which one of the following statements best describes the requirements for physical health examinations of school faculty and staff in your state? Physical health examinations are required of all school faculty and staff prior to employment. 1 Physical health examinations are required depending on the position the person will have at the school. 2 Physical health examinations are required depending on something other than the person’s position. 3 Physical health examinations are not required of any school faculty or staff prior to employment. 4 11. Which one of the following statements best describes the requirements for tuberculosis (TB) screening of school faculty and staff in your state? TB screening is required of all school faculty and staff prior to employment. 1 TB screening is required depending on the position the person will have at the school. 2 TB screening is required depending on something other than the person’s position. 3 TB screening is not required of any school faculty or staff prior to employment. 4 12. Which one of the following statements best describes the requirements for illegal drug use screening of school faculty and staff in your state? Drug screening is required of all school faculty and staff prior to employment. 1 Drug screening is required depending on the position the person will have at the school. 2 Drug screening is required depending on something other than the person’s position. 3 Drug screening is not required of any school faculty or staff prior to employment. 4 13. These last questions ask about health examinations and screenings that school faculty and staff are required to receive periodically while they are employed. Which one of the following statements best describes the requirements for physical health examinations of school faculty and staff while they are employed? Physical health examinations are periodically required of all school faculty and staff while employed 1 Physical health examinations are periodically required depending on the position the person has at the school. 2 Physical health examinations are periodically required depending on something other than the person’s position. 3 Physical health examinations are not required of any school faculty or staff while employed. 4 14. Which one of the following statements best describes the requirements for tuberculosis (TB) screening of school faculty and staff while they are employed in your state? TB screening is periodically required of all school faculty and staff while employed. 1 TB screening is periodically required depending on the position the person has at the school. 2 TB screening is periodically required depending on something other than the person’s position. 3 TB screening is not required of any school faculty or staff while employed. 4 15. Which one of the following statements best describes the requirements for illegal drug use screening of school faculty and staff in your state? Drug screening is periodically required of all school faculty and staff while employed. 1 Drug screening is periodically required depending on the position the person has at the school. 2 Drug screening is periodically required depending on something other than the person’s position. 3 Drug screening is not required of any school faculty or staff while employed. 4 If you would like to provide any additional comments, please use the space below. Thank you very much for taking the time to participate in this study. Additional Comments Please return this questionnaire to: Don Evers Research Triangle Institute P.O. Box 12194 Research Triangle Park, NC 27709 Faculty and Staff Health Promotion State Questionnaire - Final Version — Revised: 10/26/99 8 Faculty and Staff Health Promotion State Questionnaire - Final Version — Revised: 10/26/99 Other Health Promotion Activities and Services Required Examinations and Screenings