Oklahoma Certified Healthy Business Form

The Oklahoma Certified Healthy Businesses Program seeks to recognize those businesses (both profit and non-profit) that are working to improve Oklahoma’s health status by providing health and wellness opportunities for their employees.

Upon review of the tally sheet, those businesses that meet the criteria and become certified will be honored in December during the annual Oklahoma Turning Point Council Forum. Thank you for your participation!

Contact Name

Business Name

Number of Employees

Address

City
State
Zip Code
E-mail
Telephone
Fax

Check if your business/workplace is profit, non-proift, or education:

Profit
Non-profit
Education

Check the screenings/evaluation and preventive programs your workplace provides:
(Value: 1 point per checked item)

health risk appraisal
free annual physical exams for employees
cardiovascular fitness evaluation
cholesterol screening
blood pressure screening
body fat evaluation
follow-up/retest
offer flu shots to employees at the worksite
other (please specify below; e.g., flexibility, back, strengthening, etc.)
offers items this category to family members

Other Screening

Check the health promotion and education materials or courses your workplace provides:
(Value: 1/2 point per checked item)

pamphlets/brochures
posted printed material
newsletters
health topics in electronic media
paycheck stuffer on health topics
other (please specify below)
offers items this category to family members

Other Education Materials

Check all the physical activities offered by your workplace:
(Value: 1 point per checked item)

provides space for employees to exercise
offers exercise activities (walking, step aerobics, etc.)
fitness room/equipment
off-set the cost of off-site fitness center memberships
offers organized team sports (softball, soccer, etc.)
provides pedometers
provides breaks/time off to exercise
other (please specify below)
offers items this category to family members

Other Physical Activity

Check all the tobacco use prevention activities offered by your workplace:
(Value: 1 point per checked item)

***To help promote and encourage a tobacco-free lifestyle, all companies/workplaces seeking to achieve the highest level of certification (Excellence) must have in effect a 100% tobacco-free workplace policy that applies to the entire property under their control, both indoors and outdoors.***

100% tobacco-free property (see above)
free cessation products provided twice per year
active promotion of Oklahoma Tobacco Quit Line (1-800-QUIT-NOW)
onsite tobacco cessation programs
other (please specify below)
offers items this category to family members

Other Tobacco Use Prevention

Check the management support your workplace receives to promote employee health and safety:
(Value: 1 point per checked item)

offer health insurance to employees at no cost (or reduced cost)
provides space for breastfeeding mothers
incentive programs/contests
financial rewards
employee support groups
health/wellness committees in place
employee assistance programs (EAP)
mandatory seat bestuse policy

onsite safety course (lifting/exercise)
onsite disease management program
stress management programs
provides CPR/AED certification opportunities
other (please specify below)
offers items this category to family members

Other Management Support

Check all programs and information related to nutrition provided by your workplace:
(Value: 1 point per checked item)

promote healthy menu items in the cafeteria (if applicable)
offer healthy vending machine selections (fruit juices, salads, pretzels,
      low- fat yogurt, etc.)
encourage employees to bring healthy snacks
post nutritional information in break areas
onsite Weight Watchers or similar program
other (please specify below)
offers items this category to family members

Other Nutrition Information

Check the ways your workplace involves the community in your wellness model:
(Value: 1/2 point per checked item)

shares education or promotional materials
invites other groups or companies to participate in the physical
     activities offered by your company
conducts screenings/evaluations to at risk groups in the community
supports blood donor programs
other (please specify below)
offers items this category to family members

Other Community Involvement