Baseline Survey Questionnaire Management

INSTRUCTIONS: The following questions are asked to obtain information on the health policies of the company, and the programs and services it provides employees. This questionnaire will also assess your perception of the companys role in keeping its employees healthy. A. Assessment/Evaluation A1. Does the company keep/gather information on employee health habits and needs? No, go to B1. Yes, go to the next question. A2. What data gathering methods does the company use and how often? Monthly Quarterly Bi-annually Periodic survey Employee Interview Outsource study Others A3. Is the data gathered used in developing the following? Check all that apply. Health policies Yes Health programs/services Yes Annually Others

No No

(Note: Policy refers to a plan or course of action intended to influence and determine business decisions, actions, and other matters on health-related concerns; program refers to actual services, opportunities, or projects offered or made possible by the company and are designed to meet employees health needs.) A4. [Optional] Based on data gathered, what is the most pressing health concern within the organization? Please rank the following health domains, one being the most pressing, 7 being the least pressing: Food and Nutrition Physical Activity Tobacco, drugs, and alcohol Breastfeeding STI and HIV Tuberculosis Stress and psychosocial well being ___________ ___________ ___________ ___________ ___________ ___________ ___________

A5. Are there any other health domains which your company is concerned about? Yes, please specify _________________________________________________ None A6. [Optional] Do employees participate in developing communication and awareness-raising strategies, messages and materials promoting healthy lifestyle in the workplace? Yes, please specify output/s: __________________________ No B. General Health Policies and Programs B1. Does the company have a general policy on health and fitness? Yes (check both if joint project) Company Initiated by Funded by Implemented by None

Other entities (e.g., DOLE, ILO)

(Note: DOLE - Department of Labor and Employment; ILO - International Labour Organization)

Baseline Survey Questionnaire Management

B2. What types of health-related programs and services are available to employees? Yes No Emergency Medical and Dental Services If yes, please specify type of healthcare professionals dispensing health/medical advice from the options below Graduate first-aider Registered nurse Physician Dentist Emergency clinic Part-time Full-time

Pre-employment medical exam Yes, Free of Charge Yes, Subsidized No Annual physical exam Yes, Free of Charge Yes, Subsidized No Training of Personnel in Safety and Health Yes No How many employees are trained in safety and health? ___________ Does the company have a safety committee? Yes No Does the company employ a full-time safety man? Yes No Who develops and carries out its safety and health activities? Safety and health committee Contracted qualified consulting organization Health insurance Does the company provide health insurance to employees? No Only to regular employees Yes, to all employees The health insurance program is: Paid for by the company Subsidized by the company Fully deducted from employees salary B3. Who are the frontliners for implementing health-related policies and programs? Check all that apply. HR Safety/Health Committee Department Heads Team Leaders Others (please specify) ______________________________________________________ B4. What promotional tools does the company use to engage employees to avail themselves of healthrelated programs and services? Flyers Posters Newsletter Bulletin board Website E-mail Social networking sites Symposium Seminar Peer counseling Professional counseling Company events Others (please specify) ______________________________________________________

Baseline Survey Questionnaire Management

B5. Does the company have a feedback mechanism to assess the following? Health policies Yes, please state mechanism used: ________________ Health programs Yes, please state mechanism used: ________________

No No

B6. What challenges has the company encountered in implementing its health-related policies and programs? Check all that apply. Lack of funding Low employee engagement Lack of resources (i.e. resource persons, literature, information) Lack of qualified implementing personnel Company has other priorities Others (please specify) ______________________________________________________ C. Food and Nutrition (Note: For questions C1 to C8, policy refers to a plan or course of action intended to influence and determine business decisions, actions, and other matters on health-related concerns; program refers to actual services, opportunities, or projects offered or made possible by the company and are designed to meet employees health needs.) C1. Does the company have specific policies on proper nutrition among employees? Yes, please specify: _______________________________________________________ None (please go to C5) C2. Does the company have a formal feedback mechanism to assess the effectiveness of the company policy on food and nutrition? None Yes C3. Based on the feedback (formal or informal), how would you evaluate the policy on food and nutrition? Very effective Moderately effective Feedback is neutral Ineffective Other comments: ___________________________________________________________ C4. Based on feedback (formal or informal), what are the opportunities for improvement of company policy on food and nutrition? ____________________________________________________________________________________ C5. Does the company have specific programs to on promote nutrition among employees? Yes, please specify: _______________________________________________________ None, please go to C10. C6. Does the company have a formal feedback mechanism to assess the effectiveness of food and nutrition-related programs? None Yes C7. Based nutrition? on the feedback (formal or informal), how would you evaluate the programs on food and Very effective Moderately effective Feedback is neutral Ineffective Other comments: ___________________________________________________________

C8. Based on feedback (formal or informal), what are the opportunities for improvement of company programs on food and nutrition?

Baseline Survey Questionnaire Management

____________________________________________________________________________________ C9. If you answered Yes to C1 or C2, what tools does the company use to promote these policies and programs? Check all that apply. Flyers Posters Newsletter Bulletin board Website E-mail Social networking sites Symposium Seminar Peer counseling Professional counseling Company events Others (please specify) ______________________________________________________ C10. If you answered No to C1 or C2, please check the reasons that apply. Lack of funding No directive from management No perceived need/demand from employees Food and nutrition not an HR priority Previous initiatives were unsuccessful/unpopular Lack of resource persons or materials Others (please specify) ______________________________________________________ C11. How does the company provide food or food choices to employees? Through the company-operated canteen Through a company-contracted concessionaire Vending machines that dispense sodas and junk foods Food carts Fast-food restaurants within the office building Others (please specify) ______________________________________________________ None of the above. C12. How does the company provide information on the benefits of healthy food choices to employees? Check all that apply Flyers Posters Newsletters Bulletin board Website Email advisory Social networking sites Trained professional Others (please specify) ______________________________________________________

Baseline Survey Questionnaire Management

D. Physical Activity (Note: For questions D1 to D8, policy refers to a plan or course of action intended to influence and determine business decisions, actions, and other matters on health-related concerns; program refers to actual services, opportunities, or projects offered or made possible by the company and are designed to meet employees health needs.) D1. Does the company have specific policies to encourage physical activity? Yes, please specify: _______________________________________________________ None (please go to C5) D2. Does the company have a formal feedback mechanism to assess the effectiveness of the company policy on physical activity? None Yes D3. Based on the feedback (formal or informal), how would you evaluate the policy on food and nutrition? Very effective Moderately effective Feedback is neutral Ineffective Other comments: ___________________________________________________________ D4. Based on feedback (formal or informal), what are the opportunities for improvement of company policy on physical activity? ____________________________________________________________________________________ D5. Does the company have specific programs to on promote physical activity among employees? Yes, please specify: _______________________________________________________ None, please go to D10. D6. Does the company have a formal feedback mechanism to assess the effectiveness of programs that promote physical activity? None Yes D7. Based on the feedback (formal or informal), how would you evaluate company programs that promote physical activity? Very effective Moderately effective Feedback is neutral Ineffective Other comments: ___________________________________________________________ D8. Based on feedback (formal or informal), what are the opportunities for improvement of company programs on promoting physical activity? ____________________________________________________________________________________ D9. If you answered Yes to D1 or D5, what tools does the company use to promote these policies and programs? Check all that apply. Flyers Posters Newsletter Bulletin board Website E-mail Social networking sites Symposium Seminar Peer counseling Professional counseling

Baseline Survey Questionnaire Management

Company events Others (please specify) ______________________________________________________ D10. If you answered No to D1 or D5, please check the reasons that apply. Lack of funding No directive from management No perceived need/demand from employees Promotion of physical activity not an HR priority Previous initiatives were unsuccessful/unpopular Lack of resource persons or materials Others (please specify) ______________________________________________________ D11. Which of the following services to promote physical activity does the company provide? Access to a company-operated and maintained fitness gym Free membership to health and fitness gym or club Support for sports/activity groups Regular sports fest Others (please specify) ______________________________________________________ D12. How does the company provide information on the benefits of physical activity to employees? Check all that apply Flyers Posters Newsletters Bulletin board Website Email advisory Social networking sites Trained professional Others (please specify) ______________________________________________________ E. Tobacco, Drug and Alcohol Use (Note: For questions E1 to E8, policy refers to a plan or course of action intended to influence and determine business decisions, actions, and other matters on health-related concerns; program refers to actual services, opportunities, or projects offered or made possible by the company and are designed to meet employees health needs.) E1. Does the company have specific policies on following? Yes, please specify Tobacco ______________________________________________________________ Alcohol ______________________________________________________________ Drugs ______________________________________________________________ If you answered None to all, please go to E5. E2. Does the company have a formal substance abuse? Tobacco Yes None feedback mechanism to assess the effectiveness of its policy on Drugs Alcohol None

Baseline Survey Questionnaire Management

E3. How would you evaluate the policy/ies effectiveness based on the feedback (formal or informal)? Tobacco Drugs Alcohol Very effective Moderately effective Feedback is neutral Ineffective Other comments: _______________________________________________________________ E4. Based on feedback (formal or informal), what are the opportunities for improvement of the companys policy on substance abuse? Tobacco: ____________________________________________________________________________________ Drugs: ____________________________________________________________________________________ Alcohol: ____________________________________________________________________________________ E5. Does the company have specific programs to prevent abuse of the following? Yes, please specify Tobacco ______________________________________________________________ Alcohol ______________________________________________________________ Drugs ______________________________________________________________ If you answered None to all, please go to E10. E6. Does the company have a formal feedback mechanism to assess the effectiveness of its programs to prevent substance abuse? Tobacco Drugs Alcohol Yes None E7. Based on the feedback (formal or informal), how would you evaluate the effectiveness of the company programs against substance abuse? Tobacco Drugs Alcohol Very effective Moderately effective Feedback is neutral Ineffective Other comments: _______________________________________________________________ E8. Based on feedback (formal or informal), what are the opportunities for improvement of the companys programs against substance abuse? Tobacco: ______________________________________________________________________________ Drugs: ________________________________________________________________________________ Alcohol: _______________________________________________________________________________ E9. If you answered any Yes to E1 or E5, what tools does the company use to promote these policies and programs? Check all that apply. Flyers Posters Newsletter Bulletin board Website E-mail Social networking sites Symposium None

Baseline Survey Questionnaire Management

Seminar Peer counseling Professional counseling Company events Others (please specify) ______________________________________________

E10. If you answered any No to E1 or E5, please check the reasons that apply. Lack of funding No directive from management No perceived need/demand from employees Initiatives on tobacco, drugs and alcohol use not an HR priority Previous initiatives were unsuccessful/unpopular Lack of resource persons or materials Others (please specify) ______________________________________________________ E11. Which apply. of the following services to address tobacco use does the company provide? Check all that

Designation of smoking areas within the company premises Prohibition against smoking inside company premises Prohibition against selling cigarettes and other tobacco products inside the company premises. Availability of trained personnel as resource/counselor for tobacco control Availability of support group for employees who want to quit smoking Others (please specify) ______________________________________________________

E12. How does the company provide information on the dangers of tobacco use to employees? Check all that apply Flyers Posters Newsletters Bulletin board Website Email advisory Social networking sites Trained professional Others (please specify) ______________________________________________________ E13. Which apply. of the following services to address alcohol use does the company provide? Check all that

Prohibition against drinking at work Prohibition against reporting for work intoxicated Availability of trained personnel as resource/counselor to provide counseling against alcohol use Availability of support group for employees who want to quit drinking alcohol Others (please specify) ______________________________________________________

E14. How does the company provide information on the dangers of alcohol consumption to employees? Check all that apply Flyers Posters Newsletters Bulletin board Website Email advisory Social networking sites Trained professional Others (please specify)_______________________________________________________

Baseline Survey Questionnaire Management

E15. Which apply. of the following services to address drug use does the company provide? Check all that Regular drug testing of employees Random drug testing of employees Availability of trained personnel as resource/counselor to provide counseling against drug use Availability of support group for employees who want to quit using drugs Mandatory drug testing as part of pre-employment medical exam Regular annual drug testing as condition for continued employment Mandatory random drug testing Others (please specify) ______________________________________________________

E16. How does the company provide information on the dangers of drug use to employees? Check all that apply Flyers Posters Newsletters Bulletin board Website Email advisory Social networking sites Trained professional Others (please specify) ______________________________________________________ E17. Has the company ever partnered with/solicited sponsorships from: Yes No Tobacco company Liquor company E18. Are you aware of: RA No. 9211 (Tobacco Regulation Act of 2003)? Yes No RA No. 9165 (Comprehensive Dangerous Drugs Act of 2002)? Yes No DOLE Department Order No. 53-03 (Guidelines for the Implementation of a Drug-Free Workplace Policies and Programs for the Private Sector? Yes No F. Breastfeeding (Note: For questions F1 to F8, policy refers to a plan or course of action intended to influence and determine business decisions, actions, and other matters on health-related concerns; program refers to actual services, opportunities, or projects offered or made possible by the company and are designed to meet employees health needs.) F1. Does the company have a specific policy on breastfeeding? Yes, please specify: _________________________________________________________ None, go to C5. F2. Does the company have a formal feedback mechanism to assess the effectiveness of the company policy on breastfeeding? Yes None F3. How would you evaluate the breastfeeding policys effectiveness based on the feedback (formal or informal)? Very effective Moderately effective Feedback is neutral Ineffective Other comments: ___________________________________________________________

Baseline Survey Questionnaire Management

F4. Based on feedback (formal or informal), what are the opportunities for improvement of the following? ____________________________________________________________________________________ F5. Does the company have specific programs to promote breastfeeding or support nursing employees? Yes, please specify: _________________________________________________________ None, please go to F10. F6. Does the company have a formal feedback mechanism to assess the effectiveness of company programs to promote breastfeeding or support nursing employees? Yes None F7. How would you evaluate the breastfeeding program effectiveness based on the feedback (formal or informal)? Very effective Moderately effective Feedback is neutral Ineffective Other comments: ___________________________________________________________ F8. Based on feedback (formal or informal), what are the opportunities for improvement of company programs on breastfeeding? ____________________________________________________________________________________ F9. If you answered Yes to F1 or F5, what tools does the company use to promote these policies and programs? Check all that apply. Flyers Posters Newsletter Bulletin board Website E-mail Social networking sites Symposium Seminar Peer counseling Professional counseling Company events Others (please specify) ______________________________________________ F10. If you answered No to F1 or F5, please check the reasons that apply. Lack of funding No directive from management No perceived need/demand from employees Breastfeeding not an HR priority Previous initiatives were unsuccessful/unpopular Lack of resource persons or materials Others (please specify) ______________________________________________________ F11. Which of the following services to promote/support breastfeeding does the company provide? Check all that apply. Availability of facilities, equipment and supplies for breast milk collection Availability of facilities, equipment and supplies for breast milk storage Availability of facilities, equipment and supplies for breastfeeding Special breaks or allowances to allow nursing employees to breastfeed or to collect or store breast milk Availability of a milk bank where nursing employees may donate or get breast milk Others (please specify) ______________________________________________________

Baseline Survey Questionnaire Management

F12. How does the company provide information on the benefits of breastfeeding to employees? Check all that apply Flyers Posters Newsletters Bulletin board Website Email advisory Social networking sites Trained professional Others (please specify) ______________________________________________________ F13. Has the company ever partnered with/solicited sponsorship from any formula milk brand? No Yes F14. Are you aware of: RA No. 7600 (Rooming-In and Breastfeeding Act of 1992)? RA No. 10028 (Expanded Breastfeeding Promotion Act of 2009)? G. STIs and HIV (Note: For questions G1 to G8, policy refers to a plan or course of action intended to influence and determine business decisions, actions, and other matters on health-related concerns; program refers to actual services, opportunities, or projects offered or made possible by the company and are designed to meet employees health needs.) G1. Does the company have specific policies related to Sexually Transmitted Infections (STIs) and Human Immunodeficiency Virus (HIV)? HIV STIs Yes, please specify None ______________________________________________________________ ______________________________________________________________ Yes No

If you answered None to both, please go to G5. G2. Does the company have a formal feedback mechanism to assess the effectiveness of its policy on STIs and HIV? No Yes G3. How would you evaluate the effectiveness of the policy related to STIs and HIV based on the feedback (formal or informal)? Very effective Moderately effective Feedback is neutral Ineffective Other comments: ___________________________________________________________ G4. Based on feedback (formal or informal), what are the opportunities for improvement of the companys policy related to STIs and HIV? ____________________________________________________________________________________ G5. Does the company have specific programs to help address STIs or HIV? Yes, please specify None HIV ______________________________________________________________ STIs ______________________________________________________________ If you answered None to both, please go to G10.

Baseline Survey Questionnaire Management

G6. Does the company have a formal feedback mechanism to assess the effectiveness of its programs to address STIs and HIV? No Yes G7. How would you evaluate the effectiveness of these programs based on the feedback (formal or informal)? Very effective Moderately effective Feedback is neutral Ineffective Other comments: ___________________________________________________________ G8. Based on feedback (formal or informal), what are the opportunities for improvement of the companys programs to address the spread of STIs and HIV? ____________________________________________________________________________________ G9. If you answered any Yes to G1 or G5, what tools does the company use to promote these policies and programs? Check all that apply. Flyers Posters Newsletter Bulletin board Website E-mail Social networking sites Symposium Seminar Peer counseling Professional counseling Company events Others (please specify) ______________________________________________

G10. If you answered None to G1 and G5, please check the reasons that apply. Lack of funding No directive from management No perceived need/demand from employees STIs/HIV not an HR priority Previous initiatives were unsuccessful/unpopular Lack of resource persons or materials Others (please specify) _____________________________________________________ G11. Which of the following services to promote/support safe sexual behavior does the company provide? Check all that apply. Education program on responsible sexual behavior Education program on confidentiality and non-discrimination of persons with STIs or HIV Education program on risk factors, diagnosis and treatment of STIs and HIV Training of employee advocates on STIs/HIV Establishment of support or peer groups Distribution of condoms by HR/safety committee/in-house medical professional Access to condoms via distribution points (e.g. vendo machines) within the company premises Free STI diagnosis and treatment within in-house medical facilities Free STI diagnosis and treatment through HMO Free HIV diagnosis and treatment within in-house medical facilities Free HIV diagnosis and treatment through HMO Privacy and confidentiality policies to protect persons with STIs or HIV HIV/STI screening as part of pre-employment medical exam HIV/STI screening as part of required annual medical exam

Baseline Survey Questionnaire Management

Access to AIDS treatment and care for diagnosed employees Continuing salary and other benefits to diagnosed employees Others (please specify) ______________________________________________________ G12. How does the company provide information on STI/HIV risk factors, diagnosis and treatment to employees? Check all that apply Flyers Posters Newsletters Bulletin board Website Email advisory Social networking sites Trained professional Others (please specify) ______________________________________________________ G13. Are you aware of: Yes RA No. 8504 (Philippine AIDS Prevention and Control Act of 1998)? DOLE Department Order No. 102-10 (Guidelines for Implementation of HIV&AIDS Prevention)? No

H. Tuberculosis (Note: For questions H1 to H8, policy refers to a plan or course of action intended to influence and determine business decisions, actions, and other matters on health-related concerns; program refers to actual services, opportunities, or projects offered or made possible by the company and are designed to meet employees health needs.) H1. Does the company have specific policies to address the spread of tuberculosis? Yes, please specify: _________________________________________________________ None, go to H5. H2. Does the company have a formal feedback mechanism to assess the effectiveness of its policy on tuberculosis? No Yes

Baseline Survey Questionnaire Management

H3. How would you evaluate the effectiveness of the company policy on tuberculosis based on the feedback (formal or informal)? Very effective Moderately effective Feedback is neutral Ineffective Other comments: ___________________________________________________________ H4. Based on feedback (formal or informal), what are the opportunities for improvement of the companys policy on tuberculosis? ___________________________________________________________________________________ H5. Does the company have specific programs offered to address the spread of tuberculosis? Yes, please specify: _________________________________________________________ None, go to H10. H6. Does the company have a formal feedback mechanism to assess the effectiveness of its programs on tuberculosis? No Yes H7. How would you evaluate the effectiveness of the programs on tuberculosis based on the feedback (formal or informal)? Very effective Moderately effective Feedback is neutral Ineffective Other comments: ___________________________________________________________ H8. Based on feedback (formal or informal), what are the opportunities for improvement of the companys programs on tuberculosis? ___________________________________________________________________________________ H9. If you answered Yes to H1 or H5, what tools does the company use to promote these policies and programs? Check all that apply. Flyers Posters Newsletter Bulletin board Website E-mail Social networking sites Symposium Seminar Peer counseling Professional counseling Company events Others (please specify) ______________________________________________

H10. If you answered No to H1 or H5, please check the reasons that apply. Lack of funding No directive from management No perceived need/demand from employees Tuberculosis not an HR priority Previous initiatives were unsuccessful/unpopular Lack of resource persons or materials Others (please specify) ______________________________________________________

Baseline Survey Questionnaire Management

H11. Which apply. of the following services to address tuberculosis does the company provide? Check all that Education program on tuberculosis risk factors, diagnosis and treatment Availability of trained in-house medical personnel for consultation, diagnosis and treatment Access to consultation, diagnosis and treatment via HMO Others (please specify) ______________________________________________________

H12. How does the company provide information on tuberculosis risk factors, diagnosis and treatment to employees? Check all that apply Flyers Posters Newsletters Bulletin board Website Email advisory Social networking sites Trained professional Others (please specify) ______________________________________________________ H13. Are you aware of DOLE Department Order No. 73-05 (Guidelines for the Implementation of Policy and Program on Tuberculosis Prevention and Control in the Workplace)? No Yes Thank you for completing this questionnaire.