Survey | Qualtrics Survey Software

As part of our effort to help employers design effective strategies to mitigate and manage the H1N1 virus threat, we invite you to share your workplace preparation practices. Please complete the following questionnaire. Upon completion of the survey, you will be able to view the results.

A. General Practices and Policies:

As part of our effort to help employers design effective strategies to mitigate and manage the H1N1 virus threat, we invite you to share your workplace preparation practices. Please complete the following questionnaire. Upon completion of the survey, you will be able to view the results.

**A. General Practices and Policies:**
			Yes	No	N/A
1. Did your business develop any written emergency plans or revise existing plans related to influenza H1N1?
2. Have you planned for the impact of a pandemic on your business?
3. Have you prepared for the impact of a pandemic on your employees and customers?
4. Have you established policies to be implemented during a pandemic?
5. Have you allocated resources to protect your employees and customers during a pandemic?
6. Have you communicated to and educated your employees on your plans, procedures, and preventative measures for a pandemic?
7. Have you coordinated with external organizations and community groups in your preparation efforts?
8. Have you altered your travel policy?
9. Does your business offer health insurance or reimbursement for health care expenses to employees?
10. Does your business participate in any program to encourage yearly vaccination against the seasonal flu among employees?

FLU SHOTS

**FLU SHOTS**
			Yes	No	N/A
11. Is your company paying for employees to receive the flu shot?
12. Are you paying for someone to come on-site and administer the flu shot to your employees?
13. If an employee chooses to get the flu shot from an outside source, will your company subsidize part or all of the expense?

C: Please indicate your company's location, major industry, and employment size:

**C: Please indicate your company's location, major industry, and employment size:**
Location:
Major Industry:
Employment Size:

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