_______ Employee assistance program _______ Exercise/fitness program _______ First aid/CPR for employees _______ General health counseling _______ General health education _______ Glaucoma screening _______ Hazardous materials management (hazard communication) _______ Healthy back program _______ Health risk appraisals _______ Hearing protection program _______ Hepatitis screening _______ HIV screening _______ HIV counseling _______ Home visiting _______ Hypertension management _______ Hypertension screening _______ Immunizations _______ Monitoring/surveillance of employees 349 _______ Retirement planning _______ Return to work _______ Smoking cessation program _______ Stress management program _______ Travel health _______ Treatment of non-occupational illness/injury _______ Treatment of occupational illness/injury _______ Tuberculin skin testing _______ Urine drug testing _______ pre-placement _______ for cause _______ random _______ Vision protection program _______ Weight reduction program _______ Other (specify)________________________________________ _______________________________________________ ______ Other (specify)________________________________________ _______________________________________________________________________________________________________ When are group health education/promotion programs conducted? ______ percent on company time ______ percent on employee time ______ not offered Comments: ____________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Please indicate what, if any, mandated programs are in place and to what extent they are observed and enforced. _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Guideline continues on next page Worksite Assessment Guide (continued)