The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

YzTIDgf9aHWppTedbgGZ59ovHBAnSJf9wh23fh57DvuznDW5ME2kKemIdE

Reducing Employee Risk: COVID-19, Tobacco Use and Smoke-free Environments Webinar Registration

Please complete the registration information below for our collaborative Reducing Employee Risk: COVID-19, Tobacco Use and Smoke-free Environments Webinar for Thursday, September 24th from 12:30-1 pm EST/11:30-12 pm CST.

After you complete the registration, you should receive an email confirmation and we will send webinar link details prior to the webinar to those who have registered.

If you have any questions related to the registration, please contact Jane Morgan, Jane.Morgan@uky.edu.

If you have any questions related to the webinar content, please contact Jennifer Knight, jennifer.knight@uky.edu.

Thank you!

Kentucky Cancer Consortium, Kentucky Cancer Program and the Kentucky Chamber of Commerce

First Name

Last Name

Email Address

* must provide value

Name of organization

Organization location: Name of County

Please describe.

What is your organization's estimated # of employees?

(Please include full-time, part-time and contract or temporary employees located in the county referenced above)

Type of Organization (choose all that apply)

Academia/Education

Business/For profit

Professional Association (e.g. local Chamber of Commerce)

Faith-based

Government

Health-focused

Nonprofit/Foundation

Social Service

Other

Please describe.

Does your organization have a policy that does NOT allow smoking or the use of other tobacco products (including e-cigarettes) on company owned/managed property?

Yes

Not at this time

Not at this time, but interested in developing a policy

I don't know

Other (Please specify)

reset

Please specify.

Which of the following indoor areas are covered under the policy? (Select all that apply)

All indoor workspaces

Some indoor workspaces (smoking is permitted in some indoor areas)

Company owned-managed vehicles

No indoor areas are covered under the policy

Other (please specify)

I don't know

Please specify what other indoor areas are covered under the policy.

Which of the following outdoor areas are covered under the policy? (Select all that apply)

All outdoor company-owned/managed property

Outdoor company-owned managed property excluding designated smoking areas

No outdoor areas are covered under the policy

Other (please specify)

I don't know

Please specify which other outdoor areas are covered under the policy

Does your organization experience issues or challenges with implementing or maintaining compliance with the current smoke free or tobacco-free policy?

Yes

reset

Please describe the issues or challenges your organization experiences with implementing or maintaining compliance with the current smoke free or tobacco-free policy.

Is your organization interested in obtaining additional assistance with revisions to the current smoke free or tobacco-free policy?

Yes

reset

Does your company currently offer or provide resources to employees who want to quit using tobacco products?

Yes

Not at this time

Not at this time, but interested in learning more about tobacco treatment resources for my employees

Other (Please specify)

I don't know

reset

Please specify.

Which employees have access to resources who want to quit using tobacco products? (Select all that apply)

Full-time

Part-time

Contract or temporary

Other (Please specify)

I don't know

Please specify.

What resources are available for employees who want to quit using tobacco products? (Please select all that apply).

Tobacco treatment resources or services as part of health plan benefits

Free tobacco treatment resources and services from the Kentucky Tobacco Quitline 1-800-QUIT-NOW (and/or online version QuitNow KY)

Tobacco Treatment Classes (e.g. Freedom from Smoking from American Lung Association)

Tobacco treatment resources or services provided by a local health system organization (clinic, hospital, physician office)

Other (please specify)

Please specify what other resources are available to employees who want to quit using tobacco products.

The Kentucky Cancer Consortium is updating our state "Cancer Action Plan" and we are starting with the topic of "tobacco risk reduction." Would you like to be part of a virtual workgroup to provide input on updating our plan?

(This would include helping us set priorities, identify resources, and how to make the Cancer Action Plan a user-friendly resource for multiple types of organizations. We anticipate hosting 2 workgroup meetings and reviewing documents in between.)

Yes

reset

What role(s) would you like to play in the Cancer Action Plan Tobacco Risk Reduction Revision workgroup?

Provide resources

Review drafts

Make recommendations

Other

Please specify.

Thank you for completing this registration form! We look forward to having you participate in the Reducing Employee Risk: COVID-19, Tobacco Use and Smoke-free Environments Webinar on Thursday, September 24th from 12:30-1 pm EST/11:30 am - 12:00 pm CST.

Please include any questions or comments related to the webinar here:

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.