Take Survey
How serious a problem is tobacco use among employees and their dependents for your business?
(Use a scale of 1 to 5 where 5 means “very serious” and 1 means “not serious at all.”)
1 2 3 4 5  
 
How useful did you find each of the pieces in this packet in terms of increasing your knowledge of how tobacco affects business and what you can do about it?
(Use a scale of 1 to 5 where 5 means “very useful” and 1 means “not useful at all.”)
Serious Impact: Tobacco Use Hurts Your Bottom Line
1 2 3 4 5  
 
Serious Gains: Reducing Tobacco Use Improves Productivity and Profit
1 2 3 4 5  
 
Maximum Return: Healthier Communities Benefit Business
1 2 3 4 5  
 
The Packet Overall
1 2 3 4 5  
 
How likely are you/ is your business to do each of the following?
(Use a scale of 1 to 5 where 5 means “very likely” and 1 means “not at all likely.” If you have already taken the action please check that column. )
Make your workplace completely smoke-free
1 2 3 4 5  
Expand coverage for smoking cessation counseling and medications through your health plan
1 2 3 4 5  
Offer cessation assistance to employees on-site or through a contract with an outside provider
1 2 3 4 5  
Get involved with your state or local tobacco control program in your community
1 2 3 4 5  
Get involved in your state or community in affecting public policy on tobacco issues (e.g., smoke-free laws, tobacco taxes, tobacco prevention funding)
1 2 3 4 5  
Recommend the materials in this packet to other business people
1 2 3 4 5  
 
Any Other Comments :