FSHP_School - public use Form Approved OMB No: 0920-0445 Expiration Date: 11/30/2008 Faculty and Staff Health Promotion School Questionnaire Faculty and Staff Health Promotion School Questionnaire Questions Health Insurance 1 - 3 Required Examinations and Screenings 4 - 10 Health Promotion Activities and Services 11 - 15 Employee Assistance Programs 16 Health Risk Appraisals 17 - 19 Off-site Health Promotion Activities 20 Planning and Coordination 21 - 30 Public reporting burden for this collection of information is estimated to average 25 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-74, Atlanta, GA 30333; Attention PRA (0920-0445). NOTE: THROUGHOUT THIS QUESTIONNAIRE, TEXT THAT APPEARS IN ALL CAPITAL LETTERS WILL NOT BE READ ALOUD TO RESPONDENTS. THIS QUESTIONNAIRE WILL BE ADMINISTERED USING COMPUTER-ASSISTED PERSONAL INTERVIEWING TECHNOLOGY. THE INTERVIEWER WILL READ THE QUESTIONS ALOUD AND TYPE RESPONSES TO THE QUESTIONS INTO THE LAPTOP COMPUTER. THE INTERVIEW PROGRAM WILL 1) DISPLAY THE CORRECT TENSE OF VERBS, 2) PROVIDE ALTERNATE ANSWERS TO QUESTIONS (E.G., NOT APPLICABLE, “I DON’T KNOW”), 3) NAVIGATE COMPLEX SKIP PATTERNS, AND 4) PERFORM OTHER USEFUL FUNCTIONS. THE PROGRAMMING SPECIFICATIONS FOR THE INTERVIEW ARE NOT INCLUDED IN THIS PRINTED VERSION OF THE QUESTIONNAIRE. 1. What is your job title at the school? (In which role do you spend more time?) 1) Principal 11) School Counselor 2) Asst. Principal/Other School 12) Social Worker Administrator 13) Psychologist 3) School Secretary 14) Other Mental Health/Social Services 4) Physical Ed Teacher Provider 5) Athletic Director 15) Nurse 6) Health Ed Teacher 16) Health Aide 7) Other Teacher 17) Physician 8) Food Service Manager 18) Other Health Services Provider 9) Commercial Food Service Provider 19) SBHC Health Services Staff 10) Other School Food Service Staff 20) SBHC Mental Health/Social Services Staff 50) Other Staff During this interview, I will ask about health promotion activities or services that are offered to this school’s faculty and staff because they work for this school. 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. Please include those activities or services offered by your state, district, school, or anyone outside the school system. If I ask you about things that do not apply to this school or that this school does not do, please bear with me. IF THIS SCHOOL IS A PUBLIC SCHOOL, SKIP TO THE INTRODUCTION TO Q4. IF THIS SCHOOL IS A PRIVATE SCHOOL, CONTINUE TO THE INTRODUCTION TO Q2. The first question asks about health insurance that may be offered by your school. By offer, I mean that the school pays for some or all of the cost of the insurance or makes the insurance available to faculty and staff at their own expense. 2. Does your school offer health insurance to faculty and staff? Yes 1 No 2-->SKIP TO THE INTRODUCTION TO Q4 3. Does this health insurance cover all or part of the following for faculty and staff? Yes No a. Preventive health care, such as physicals 1 2 b. Vision care 1 2 c. Dental care 1 2 d. Immunizations 1 2 e. Mental health care 1 2 f. Alcohol or other drug use treatment 1 2 Next, I would like to ask about faculty and staff health examinations and screenings required for employment. SHOW CARD 1 4. Please tell me which of the statements on this card best describes the requirement for a physical health examination of faculty and staff prior to employment. Physical health examinations are required of all faculty and staff prior to employment. 1 Physical health examinations are required prior to employment depending on the position the person will have. 2 Physical health examinations are required prior to employment depending on something other than the person’s position. 3 Physical health examinations are not required of any faculty or staff prior to employment. 4 SHOW CARD 2 5. Which of the statements on this card best describes the requirement for illegal drug use screening of faculty and staff prior to employment? Drug screening is required of all faculty and staff prior to employment. 1 Drug screening is required prior to employment depending on the person’s position. 2 Drug screening is required prior to employment depending on something other than the person’s position. 3 Drug screening is not required of any faculty or staff prior to employment. 4 SHOW CARD 3 6. Which of the statements on this card best describes your school’s requirement for tuberculosis or TB testing of faculty and staff prior to employment? TB testing is required prior to employment for all faculty and staff 1 TB testing is required prior to employment depending on the person’s position 2 TB testing is required prior to employment only for faculty and staff meeting certain risk criteria, for example those born or recently living in other countries 3 TB testing is not required prior to school employment for any faculty or staff 4 SHOW CARD 4 The next question asks about examinations and screenings that this school’s faculty and staff are required to receive periodically while they are employed at this school. 7. Which of the statements on this card best describes the requirement for physical health examinations of faculty and staff while they are employed at this school? Physical health examinations are periodically required of all faculty and staff while employed. 1 Physical health examinations are periodically required depending on the person’s position. 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 faculty or staff while employed. 4 SHOW CARD 5 8. Which of the statements on this card best describes the requirement for illegal drug use screening of faculty and staff while they are employed at this school? Drug screening is periodically required of all faculty and staff while employed. 1 Drug screening is periodically required depending on the person’s position 2 Drug screening is periodically required depending on something other than the person’s position. 3 Drug screening is not required of any faculty or staff while employed. 4 SHOW CARD 6 9. Which of the statements on this card best describes your school’s requirement for routine TB testing of faculty and staff while they are employed at this school? Please do not include TB testing that might be done during a school outbreak. Periodic TB testing is required for all faculty and staff 1 Periodic TB testing is required for faculty and staff depending on the person’s position 2 Periodic TB testing is required only for faculty and staff meeting certain risk criteria, for example those born or recently living in other countries 3 Periodic TB testing is not required for any faculty and staff 4 IF Q6 = 4 AND Q9 = 4, SKIP TO THE INTRODUCTION TO Q11. 10. Which method is your school required to use when initially screening faculty and staff for TB? PPD skin test done by Mantoux method, 1 Skin test not otherwise specified, 2 Chest x-ray, or 3 Is no specific testing method required? 4 The remainder of the interview asks about faculty and staff health promotion activities or services. 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 faculty and staff experiencing problems that can impact job performance, physical health, or overall well-being. We are interested in activities and services schools may provide to faculty and staff because they are employees, not because they take part in the school health insurance. The next questions ask about health screenings for faculty and staff. 11. During the past 12 months, has your school offered the following screenings for faculty and staff? Yes No a. Oral health screening 1 2 b. Height and weight or body mass screening 1 2 c. Serum cholesterol screening 1 2 d. Blood pressure level screening 1 2 e. Diabetes screening 1 2 f. Skin cancer screening 1 2 g. Breast cancer screening 1 2 h. Colorectal cancer screening 1 2 The next questions ask about health promotion activities for faculty and staff. This might include classes, workshops, distribution of materials, or individual or group counseling sessions. 12. During the past 12 months, has your school offered activities for faculty and staff related to the following? Yes No a. Nutrition education 1 2 b. Weight management 1 2 c. Worksite safety education 1 2 d. Emergency preparedness 1 2 e. Cardiopulmonary resuscitation or CPR education 1 2 f. Stress management education 1 2 g. Pre- or post-natal education 1 2 h. Conflict resolution education 1 2 i. Asthma management education 1 2 j. Diabetes management education 1 2 k. Tobacco use cessation 1 2 l. Physical activity and fitness counseling 1 2 m. Counseling for emotional disorders, such as anxiety or depression 1 2 n. Crisis intervention for personal problems 1 2 13. During the past 12 months, has your school offered the following services for faculty and staff? Yes No a. Referrals for child care or elder care 1 2 b. Referrals for oral health problems 1 2 c. Immunizations, not including those covered through health insurance, for example flu vaccines 1 2 d. Identification of or referrals for physical, sexual, or emotional abuse 1 2 14. During the past 12 months, have any physical activity programs, such as aerobics classes, basketball leagues, or walking or jogging clubs been offered to this school’s faculty and staff? Yes 1 No 2 I’d like to ask about the use of school facilities or equipment that could be used for physical activity, such as a gym, cafeteria, swimming pool, weight-lifting equipment, and cardiovascular exercise equipment. 15. Are any indoor or outdoor school facilities or equipment made available for this school’s faculty or staff to use? Remember, we are talking about facilities or equipment that are available to faculty and staff because they work at this school. Do not consider facilities or equipment that are available to all residents of a community. Yes 1 No 2 Next, I’d like to ask you about Employee Assistance Programs, or EAPs. EAPs provide services designed to assist faculty and staff experiencing personal or social problems that can impact work performance, physical health, or overall well-being. 16. During the past 12 months, has an EAP been offered to this school’s faculty and staff? Yes 1 No 2 The next questions ask about health risk appraisals. A health risk appraisal is a questionnaire used to assess self-reported risk factors, such as smoking and physical inactivity. Some people may refer to this as a health risk survey. 17. During the past 12 months, has your school provided health risk appraisals for faculty and staff? Yes 1 No 2-->SKIP TO Q20 18. During the past 12 months, if the health risk appraisal identified individual problems, were follow-up services or referrals offered? Yes 1 No 2 Health risk appraisal did not identify any problems 3 19. During the past 12 months, was information from health risk appraisals used to develop health promotion programs such as health screenings, health education, or health counseling for faculty and staff? Yes 1 No 2 The next question asks about off-site health promotion activities. 20. Do this school’s faculty and staff receive any subsidies or discounts for off-site health promotion activities, such as health club memberships, weight loss programs, or tobacco use cessation programs? Yes 1 No 2 IF Q11A-H ARE “NO”, Q12A-N ARE “NO”, Q13A-D ARE “NO”, Q14 IS “NO”, Q16 IS “NO”, Q17 IS “NO”, AND Q20 IS “NO”, SKIP TO Q30. The next questions ask about objectives that are considered when planning health promotion activities or services for faculty and staff. 21. When planning activities or services for faculty and staff, is consideration given to... Yes No a. Reducing the number of sick days used? 1 2 b. Reducing the use or cost of health insurance benefits? 1 2 c. Reducing the number of faculty and staff injuries? 1 2 d. Improving faculty and staff morale? 1 2 e. Creating an environment in which faculty and staff serve as “healthy” role models for students? 1 2 f. Attracting and retaining good faculty and staff? 1 2 g. Improving job performance? 1 2 h. Addressing the health needs of faculty and staff? 1 2 i. Creating a positive image in the community? 1 2 22. During the past two years, has your school assessed faculty and staff satisfaction with health promotion activities or services? Yes 1 No 2 The next question asks about incentives faculty and staff might receive for participation in health promotion activities. 23. During the past 12 months, has your school provided any of the following incentives for faculty and staff participation in health promotion programs? Yes No a. Monetary incentives 1 2 b. Gifts 1 2 c. Paid time off 1 2 d. Health insurance premium discounts 1 2 e. Certificates or awards 1 2 f. Public recognition 1 2 SHOW CARD 7 24. During the past 12 months, have any activities or services been offered to this school’s faculty and staff by the following organizations or agencies? Yes No N/A a. Your school district 1 2 3 b. A local health department 1 2 3 c. A local hospital 1 2 3 d. A local mental health or social services agency 1 2 3 e. A university or medical school 1 2 3 f. A managed care organization 1 2 3 g. Any health organization, such as the American Heart Association or the American Cancer Society 1 2 3 h. A local health or fitness club 1 2 3 i. A local business 1 2 The next questions ask about ways to promote health programs for faculty and staff. 25. During the past 12 months, have the following actions been taken to publicize the health promotion activities or services offered to faculty and staff? Yes No a. Notices been included with paychecks or sent with pay stubs 1 2 b. Fliers or bulletins been posted at the school 1 2 c. Letters been mailed directly to faculty and staff 1 2 d. Announcements been made at staff meetings 1 2 e. Special assemblies or presentations been offered 1 2 f. Emails been sent to faculty and staff 1 2 g. Notices been posted on the school web site 1 2 h. Notices or articles appeared in school newsletters or newspapers 1 2 26. During the past 12 months... Yes No a. Has release time for participation in health promotion activities been given? 1 2 b. Have competitions between groups of faculty and staff been held, for example, a contest between teachers from different grades or departments? 1 2 27. Currently, does someone at this school oversee or coordinate health promotion activities or services for this school’s faculty and staff? Yes 1 No 2-->SKIP TO Q30 28. Are you this person? Yes 1 No 2 29a. During the past 12 months, have you or others who oversee or coordinate health promotion activities or services for faculty and staff at this school worked on those activities with health education staff? Yes 1 No 2 School does not have health education staff 3 29b. What about with physical education staff? Yes 1 No 2 School does not have physical education staff 3 29c. What about with health services staff? Yes 1 No 2 School does not have health services staff 3 29d. What about with mental health or social services staff? Yes 1 No 2 School does not have mental health or social services staff 3 29e. What about with nutrition or food service staff? Yes 1 No 2 School does not have nutrition or food service staff 3 30. My supervisor may wish to call you to ask about how I conducted this interview. Would you please tell me a telephone number where we might reach you starting with the area code? ( ) - 1) Daytime or 2) Evening/weekend Thank you very much for taking the time to complete this questionnaire.