Tobacco Control Coalition

Organization Partnership Survey 2015

Hello. This is ___________, with the American Lung Association and the Tobacco
Control Coalition. We are doing a short survey to see how your partnership with TCC
is working for you. We want to improve our services and make sure you know we
are a resource for tobacco related information. Do you have about 5 minutes to
answer a few questions? Thank you for your participation.
1.

Since partnering with the Tobacco Control Coalition, what tobacco related
health issues do you think staff are now more aware about?

2. How has your organization used our materials? (Probe only if needed: At health
fairs or events, with clients, with staff, in areas where clients can access them, In
training, workshops, or classes)

3.

Are you aware of anyone calling the California Smokers Helpline cessation
services such as:
Referred clients?
Family members on behalf of a smoker?
Staff who smoke?

Staff on behalf of a smoker?

4. Has a No Smoking policy been adopted at your facility since partnering with the
Tobacco Control Coalition?

If no, how would you like assistance with implementing a No Smoking policy
at your worksite?

5. Do you have designated smoking areas at your facility?

6.

Do you need a sample no smoking policy statement for your employee manual?

7. Has tobacco-related information been added to your literature or educational

curriculum?

8. Is the use of E-cigarettes by clients or staff a concern at your organization?

O:\SD\Advocacy\Tobacco\TCC 2014-2017\Current Tasks\5. Evaluation\Process

Evaluation

9. Do you need information about E-cigarettes to share with staff and clients?

10.What do you think of the webinars that are announced through the Tobacco
Control Coalition?

11.Does your website have a link to the California Smokers Helpline?

12.What are other ways that tobacco information is shared at your organization?

13.In your opinion, what are the benefits to collaboration on tobacco related issues?

14.What do you think are the barriers to collaboration on community smoke-free

policies?

Thank you for your time. We have a small token of appreciation for you. Would you
like a Target gift card or 2 AMC movie passes?
Verify
Contact:
Address:
Phone:
Email:
We are sending you a care package with tobacco educational materials. Is there
anything in particular you would like? Secondhand smoke, LGBT, pregnant women,
cessation. If you think of anything else, please contact Ofelia Alvarado. Her business
card will be included in the care package we are sending you.