- Interagency Agreements
- Consortia
- Employee Welfare & Recreation Organizations
- Federal Occupational Health
- Agency Personnel
- Contractors
- Volunteers
- Healthfinder Tool
- Supertracker Tool
- Social and Environmental Supports
- On-Site Health Units
- Supports for Nutrition & Weight Management
- Garden Initiatives & Farmers Markets
- Healthy Meetings, Conferences, & Events
- On-site Federal Fitness Facilities
- Off-site Commercial Fitness Facilities
- Use of Stairwells Promotion
- Active Transportation
- Health Risk Appraisal (HRA) or Health Assessment (HA)
- Biometric Testing
- FEHB Preventive Care
- On-site Health Clinics
- Health Fairs & Special Events
- Workplace Health Screenings Fact Sheets
- Wellness Council and Committees
- Worksite Health Promotion Program Implementation/Improvement Plan Guidance
- Alternative Work Schedules & Leave
- Excused Absence
- Telework
- Federal Employee Health Benefits Program
- Federal Flexible Spending Accounts Program
- Health Saving Accounts
- Employee Assistance Program
- Leave & Workplace Flexibilities
Delivery Mechanisms
The availability of resources, number of employees, location, and nature of work define the type of worksite health & wellness programs an agency offers and the most efficient and effective delivery mechanism that should be used. Programs may be:
- Fully funded by an agency—delivered directly by agency staff, facilities, and services or delivered using agency facilities with contracted staff and services
- Funded by a combination of employee contributions or fees and agency funding
- Fully funded by employee contributions or fees
When considering possible funding sources and fee structures, consider:
- Total cost (presently and in the future) of staffing, equipment, facilities, and implementing and administering programs.
- Agency mission and employee duties.
- Financial limitations of employees at lower income levels. The size of the employee contribution should not limit or prohibit participation of employees at lower income levels. Consider financing the cost of services to the point where the contribution is reasonable for all employees.
Depending on its size and mission, an agency must determine whether to create its own program or share services with other agencies. While successful programs run on small budgets, sometimes it is more cost effective to share worksite health promotion services and facilities with other agencies in the same building or geographic location. Delivery mechanisms for such programs include interagency agreements, consortia, employee welfare and recreation organizations, and Federal Occupational Health (FOH).
Interagency Agreements (Economy Act, 31 U.S.C. 1535)
To share services, Federal agencies may enter into an interagency agreement on a reimbursable basis. This process offers a convenient alternative to contracting and is often quicker and less cumbersome than the contracting process. Agencies may choose to use one interagency agreement to provide either all of its worksite health promotion services or specific services such as periodic physical examinations for those employees with physical examinations as a condition of employment.
Consortia
When no single agency can serve as a worksite wellness service provider for similarly situated agencies, the combined employee population may pool resources and establish a worksite health promotion consortium. A lead agency enters into a contract or agreement with a service provider. An interagency agreement links participating agencies to the contract and the combined employee population enjoys access to worksite health promotion services. The lead agency must have authority to provide the services to other agencies.
Employee Welfare and Recreation Organizations
An employee welfare and recreation organization (employee organization) is comprised of interested employees who deliver organized activities and programs for their colleagues in a structured format formally recognized by agency management. All activities sponsored by employee organizations must be open to participation by all qualified employees without regard to race, color, sex, religion, national origin, age, disability, marital status, gender identity, sexual orientation, or political affiliation. An employee organization may hire its own staff or use vendors to provide services. The organization collects fees from participating employees/members to cover the costs of operating certain entities and activities, such as sundry shops, fitness centers, and snack bars. An agency may provide Government resources to support employee organizations in accordance with appropriate General Services Administration regulations contained in title 41 of the Code of Federal Regulations. When certain conditions are met, an agency may pay for the rent and maintenance of space, equipment, janitorial services, and the start-up costs of facilities managed by employee organizations. Dues may be collected directly by the organization during non-duty hours, or employee members may set up individual financial allotments to a financial institution. Arrangements for such allotments must be made directly between the employee member and his/her servicing personnel office using a Direct Deposit Sign Up Form, SF 1199A.
Federal Occupational Health (FOH)
FOH is a service unit organization within the Department of Health and Human Services' Program Support Center. FOH works in partnership with Federal agencies nationally and internationally to design and deliver comprehensive solutions to meet their occupational health, wellness and fitness needs. Services are provided on a reimbursable basis through interagency agreements. For example, FOH can staff and operate onsite health units, employee assistance programs (EAPs), and fitness facilities.
Staffing
Agencies have a variety of staffing options. Options include agency personnel, contractors, and volunteers. Each agency must ensure that personnel delivering health services are fully qualified and trained specifically to the duties assigned. Agency wellness councils or committees should work closely with selected wellness staff to ensure delivery of services that best meet the needs of an agency.
Agency Personnel
Agencies may hire employees or use existing agency personnel to develop, manage, and deliver programs. The staff may be employed either full-time or part-time, or may be assigned the duties on an “as needed” basis. Many agencies organize worksite health promotion staff and programs under one component for more efficient coordination.
Contractors
Contracted personnel can manage a comprehensive program or provide specific services, such as exercise classes or an annual health fair. Following appropriate procurement procedures, agency contracting officers may identify qualified vendors through:
- GSA Schedule Approved Contractors List
- Commercial health clubs
- Community centers
- Local hospitals
- Non-profit organizations
- Private consultants
- Universities
Volunteers
There are only very limited circumstances under which agencies may accept volunteer (gratuitous) services. Agencies should consult their General Counsel when considering this option. Agencies may provide many health activities through volunteer or no-cost arrangements while ensuring that volunteers have the skills, qualifications, and knowledge to deliver health activities. For example, a trained volunteer might give a presentation on desktop ergonomics. An intern from a local university may conduct fitness evaluations. A volunteer wellness committee may organize a lunchtime walking club. A non-profit health organization may provide free speakers for a wellness education series. Many of these local organizations provide free materials such as pamphlets, videos, and posters, especially if they tie into a national health campaign, such as the Great American Smokeout.
The Centers for Disease Control and Prevention’s Healthier Worksite Initiative (HWI) includes information on ways to provide staffing resources for workforce health promotion programs. The HWI considers an agency’s size and budget and provides information on staffing, continuing education opportunities for worksite health promotion personnel and tips for selecting a worksite health promotion contractor.
Health Education
Health education focuses on skill development and behavior change, in addition to information dissemination and increasing awareness of the importance of good health, preferably tailored to employees’ interests and needs. A key element of health education is to motivate individuals to take action to improve their own health by developing a sense of responsibility for themselves and as members of work and social populations. Agencies may provide health education to encourage employees to maintain a healthy lifestyle, to understand their risk for disease, and to become aware of appropriate preventive practices. Important considerations include accessibility to health education and engagement opportunities for those individuals with disabilities, in accordance with the each agency’s requirements under section 504 of the Rehabilitation Act (similar to accessibility requirements of the Americans with Disability Act), Equal Employment Opportunity Commission (EEOC) guidelines, and section 508 of the Rehabilitation Act.
Health education and engagement opportunities include:
- Brochures videos, posters, pamphlets, newsletters, or other written or online information that address:
- Physical activity
- Nutrition
- Weight management
- Tobacco-free living
- Risks of overweight or obesity
- Risks of high cholesterol
- Stress management
- Preventing and controlling high cholesterol
- Physical activity
- Nutrition
- Weight management
- Breastfeeding
- Tobacco cessation
- Stress management
HealthFinder Tool
Consider using healthfinder.gov as a health tool for employees. This Federal website offers quick guides to healthy living, personalized health advice, current health news, and tips and tools that streamline searches. Web syndication is available and may be linked with an agency’s website so employees have ready access to reliable health information.
USDA SuperTracker Tool
SuperTracker provides users with a practical, personalized web-based application and the “how‐tos” for making healthy food and activity choices in line with the 2010 Dietary Guidelines for Americans. SuperTracker includes tools that easily identify personal nutritional and physical activity recommendations, the ability to compare personal food choices to the Dietary Guidelines for Americans, and the means to assess personal physical activities based on the Physical Activity Guidelines for Americans. The report and graphic functions of SuperTracker enables users to measure their progress over specific periods.
Social and Environmental Support
Social and environmental supports establish an environment that encourages an active and healthy lifestyle. These programs, policies, and initiatives relay a powerful message to employees about the agency’s support of healthy behaviors, which results in a positive culture for health. There are many options for both social and physical environmental supports of health and wellness. Agencies should implement supports that are most appropriate and will have the greatest positive impact for your workforce and agency.
On-site Health Units
An on-site health unit or occupational health center (OHC) is a convenient place to provide and coordinate comprehensive health and wellness services to Federal employees. Providing services at or near the worksite minimizes employees' time away from work and enhances productivity. Consider establishing an OHC or using the services of an existing OHC when developing a worksite health promotion program.
Depending on the size of the population and needs of the employees, an agency may provide full- or part-time health center services. Smaller agencies within a building or geographic locality may consider sharing a health center and/or services or provide employees with access to a nearby off-site health center. The on-site health unit may assist employees in complying with physician-directed condition management programs.
Designs and plans for new or renovated health units or occupational health centers can be coordinated with General Services Administration (GSA) regional offices (for GSA owned or leased space) or Federal Occupational Health (FOH). FOH can help review space, supplies, and equipment needs based on an agency's population and services. FOH can also provide staff that can work with agencies to develop a comprehensive occupational health program.
An agency or agency vendor may manage the ongoing operations of the OHC, staffed with contracted health professionals. An occupational health registered nurse is recommended; however, occupational health physicians, physician's assistants, nurse practitioners, licensed practical nurses, health promotion specialists and trained technicians may all be appropriate, depending on the size, scope, and complexity of the services an agency is considering providing. The OHC staff should work in conjunction with an agency's on-site fitness facility, employee assistance counselors, human resources, and health and safety professionals wherever possible. The OHC and its staff can play a pivotal role in the effectiveness and integration of an agency's worksite health promotion program.
Supports for Nutrition & Weight Management
A strong worksite nutrition and weight management program often pays dividends outside of the worksite as behaviors transfer outside of the worksite and into the family and leisure environment. Coupled with physical activity, sound nutrition is a strong component of health.
Health and Sustainability Guidelines for Federal Concessions and Vending Operations
The General Services Administration (GSA) developed the Health and Sustainability Guidelines for Federal Concessions and Vending Operations guidelines in partnership with the Department of Health and Human Services; they represent the best practices in nutrition science for improving health and reducing impact to the environment. These new guidelines translate the 2010 Dietary Guidelines for Americans into clear and definitive standards that food service operators can follow to make their operations healthier and more sustainable. The guidelines are designed to make healthy choices more accessible, more appealing, and more affordable. They are not designed to restrict choices. The Health and Sustainability Guidelines are applicable to all food service concession operations and vending machines managed by HHS and GSA.
Garden Initiatives & Farmers Markets
One way to improve the worksite nutrition environment and provide access is to operate a garden market at the worksite, so employees can conveniently shop for fruits and vegetables. A garden market may also reduce price barriers if it provides fresh produce at prices that are competitive with other sources. The CDC created the “Garden Market” demonstration project in 2004. The Garden Market was so successful that it was adopted at other CDC locations. The availability of these types of markets continues to increase throughout Federal agencies.
Additional approaches to building a supportive nutritional environment should be explored by the employer when designing a comprehensive health and wellness program including:
- Offering nutrition education seminars
- Offering healthy choices at food sites such as cafeterias and vending machines
- Offering healthy food choices at meetings
- Offering weight management programs
Additionally, the People’s Garden Initiative began in 2009 as an effort to challenge employees to create gardens at USDA facilities. It has since grown into a collaborative effort that includes local and national organizations all working together to establish community and school gardens across the country. To be part of the initiative, a garden must meet three goals: sustainability, community involvement and public service. People’s Gardens promote health and wellness by increasing availability and access to fresh fruits and vegetables and encouraging consumption. Gardening provides a low-impact exercise for people within a large range of physical ability. People’s Gardens also enable social and cultural connections by providing a gathering place for social interaction and educational opportunities. Gardens in general promote sustainable practices and improve water quality, soil health, and wildlife habitats.
USDA employees work in their gardens early in the morning before work, after work, during their lunch breaks and even on the weekends. Employees who work on the garden often do not know each other before they start volunteering. This initiative is an excellent example of a supportive social and physical environment that encourages active and healthy lifestyles, community engagement, and a positive workplace culture.
Healthy Meetings, Conferences, and Events
Worksite health promotion leaders should encourage employees to make every effort to offer healthier options at meetings and work-related social gatherings. If food and beverages are brought in by employees as a part of the event, refer them to CDC’s guide: Choosing foods and beverages for healthy meetings, conferences, and events.
Supports for Physical Activity
Physical activity programs should be an integral part of an agency's worksite health promotion program. Agencies may operate on-site fitness facilities, use the services of a private facility, or even subsidize memberships. Fitness activities can also be provided without any special facilities. The built environment may encourage physical activity just as readily as access to a formal exercise facility. Managers may use discretion to allow other opportunities for increasing employee physical activity, such as conducting walking meetings and installing mobile work stations.
On-site Federal Fitness Facilities
An agency’s on-site fitness facility may serve as a hub of health promotion activities and services. Safety is the primary principle in any fitness facility design. The majority of accidents can be prevented through adequate supervision, staff training, appropriate screening procedures, and proper facility and equipment maintenance.
Off-Site Commercial Fitness Facilities
Providing health and fitness activities via a private facility may be part of an agency's bona fide preventive program authorized under 5 U.S.C. 7901. Agencies, in exercising this authority to purchase access to private health and fitness facilities, should use the following criteria in making the determination:
- Providing access to a private fitness facility meets agency health services program objectives and can be carefully monitored as part of a bona fide preventive health program.
- Providing access to private facilities is more cost-effective than providing an on-site fitness facility.
- Coordinating with other Federal agencies in the area to provide a multi-agency operated fitness facility is not possible.
- Other possible resources (such as other Federal fitness facilities) or typically lower-cost facilities (such as community centers or universities) were identified, considered, and determined to be unavailable or inappropriate.
The private health and fitness facility should provide preventive health programs and services that fall within the purview of 5 U.S.C. 7901. Reasonable measures should be taken to ensure the private fitness facility is the most appropriate, convenient, and cost-effective choice, and that it provides reasonable accommodations (accessibility).
When purchasing memberships:
- Purchase the memberships in the name of the agency, not in the name of the individual employee.
- Follow Government procurement guidelines when contracting with private fitness facilities to provide access for employees.
- Choose basic membership packages (if there are such options) and avoid deluxe package options (e.g., spa privileges or activities that are purely recreational and do not contribute to a bona fide preventive health program).
- Monitor the facility and the employees' use of memberships.
- Be aware that health club memberships provided to employees may be a taxable fringe benefit.
Use of Stairwells Promotion
In support of section 607 of Public Law 109-115 and the Joint Explanatory Statement for the FY 2009 Omnibus Appropriations Act, GSA is undertaking a stronger effort to promote the use of stairs in Federal buildings. Promoting the use of stairwells requires a multi-faceted approach. First, the physical and aesthetic characteristics of the stairwell should be improved to enhance the attractiveness of the space. According to the Centers for Disease Control (CDC), many employees do not take the stairs at work because they perceive them as unattractive or unsafe. However, a CDC study revealed that physical changes to the staircases can increase stairwell use among building occupants. Internal communications that encourage employees to choose the stairs regularly also are necessary to foster a shift from elevator to stairwell utilization. GSA plays an important role in advancing both of these approaches. The key message is that promoting the use of stairwells can aid in improving employee health and contribute to a reduction in energy costs. Benefits of stairwell use include:
- Potential improvement in employee health and wellness by engaging in more physical activity throughout the work day.
- Reduction in utility costs from elevator usage.
- Reduced wait times at elevators by minimizing single-stop riding.
When promoting stairwell use, consider implementing these options:
- Transform walls with paint, using bright colors.
- Add art work, photos, murals, framed cartoons or children‘s art. Rotate the artwork regularly. Test effectiveness with focus groups.
- Carpet the stairs and use rubber treading.
- Create themed stairwells, adding slogans and pictures.
- Place motivational signs inside and outside the stairwell and near the elevators to encourage participation.
- Install a sound system and set up a rotating schedule of musical selections.
- Use creative lighting and add an electronic message board.
- When building energy use is high, send building alerts to encourage employees to take the stairs instead of the elevators.
- Set up a system to track how many employees are using the stairs and examine barriers to stair usage through questionnaires and conversation with tenants.
- Interior finishes in exit stairs are required to meet the conditions outlined in the International Code Council’s International Building Code. Therefore, it is recommended that stairwell projects of any kind be reviewed by GSA regional and central office fire protection engineers.
Agencies can support healthy lifestyles and increased physical activity by creating environments that support safe and convenient commuting to work by bicycling or walking. Such environments can be created by improving the transportation network around the worksite, ensuring appropriate facilities are located within the worksite, and providing programs that support and promote active commuting:
- Transportation networks
- A key ingredient for active commuting is ensuring that the transportation facilities near worksites are safe and convenient for walkers, bicyclists, and transit users. Sidewalks should be present and well maintained to support pedestrians of all ages and abilities; and appropriate bicycle facilities, such as bicycle lanes, should be provided. If transit facilities are nearby, it may be possible for people to consider walking and bicycling for only part of their commute.
- A number of communities have (or are in the process of establishing) bike share programs. Bike share programs are structured to allow users to pick up a bicycle at a self-serve bike station and return the bike to another station. These systems can help commuters incorporate bicycling into part of their trip to work. It may be possible to work with the bike share provider to locate stations near a worksite.
- The same types of facilities that support physical activity in general, such as fitness centers, also support active commuting. For example, people who jog or bike to work will want access to showers to wash and change. Convenient, plentiful, and secure parking for bicycles is important for bicycle commuters as well. Providing overnight lockers for people to use for storing clothes and equipment (e.g., running shoes and bicycle tubes) is another bicycle-friendly practice. Some agencies, such as the Environmental Protection Agency, have received national recognition for providing exemplary facilities for bike commuters.
- The National Bike to Work Day is a popular annual initiative that encourages people to consider active commuting. Agencies should consider supporting local Bike to Work Day events or promoting National Bike Month.
- A bike subsidy for workers who commute primarily by bike is another way to support active commuting. Employers can reimburse bicycle commuters up to twenty dollars each month for expenses related to bike commuting.
- Establishing a bike commuter group at the agency can help, too. Such groups can provide training for people who are interested in bike commuting, can provide information about safe routes to work, and help foster a bicycle-friendly community.
Tobacco-Free Living Support
Tobacco use can lead to nicotine dependence and serious health problems. Cessation can significantly reduce the risk of suffering from smoking-related diseases. Tobacco dependence is a chronic condition that often requires repeated interventions, but effective treatments and helpful resources exist. The Federal Employees Health Benefits Program (FEHB) and the Centers for Disease Control and Prevention (CDC) provide several resources for tobacco control and cessation available on our Tool & Resources page.
A tobacco-free campus initiative includes a policy and comprehensive cessation services for employees designed not only to protect nonsmokers from secondhand smoke but also to encourage employees to improve their health by quitting the use of tobacco products. Tobacco-free campuses create work environments in which tobacco users find it easier to reduce their consumption or quit altogether. Tobacco-free campuses enjoy additional benefits of reduced cleaning and maintenance costs, improved fire safety, and improved worker productivity. More information can be found in the CDC’s Implementing a Tobacco-Free Campus Initiative in Your Workplace toolkit. Specific social and physical supports to consider include:
- Actively enforcing a written policy banning tobacco use;
- Displaying signs with information about your tobacco use policy;
- Referring tobacco users to tobacco cessation telephone quit lines; and
- Informing employees about health insurance coverage or programs that include tobacco cessation medication and counseling
Alternative Meeting Strategies
Consider alternative meeting strategies to incorporate health promotion activities and concepts throughout the workday. Research shows that brief physical activity breaks during a long meeting increase energy levels, attention spans, and participation, and reduce fatigue, all of which can lead to a more productive meeting. Employees who sit at a desk for 6 or more hours a day increase their risk of heart disease by 64 percent, along with the risk of contracting certain types of cancer, additional weight gain and increased cholesterol. Alternative meeting strategies include holding walking meetings, holding meetings on another floor or building to encourage movement, and using high tables without chairs.
Supports for Nursing Mothers
On December 20, 2010, President Obama delegated authority to the U.S. Office of Personnel Management (OPM) to provide guidance to executive branch civilian employees on workplace accommodations for employees who are nursing mothers. This delegation is in support of section 4207 of the Patient Protection and Affordable Care Act (Act), Pub. L. 111-148, which added a new subsection (r) to section 7 of the Fair Labor Standards Act of 1938 (FLSA) (codified as amended at 29 U.S.C. 207). This new subsection requires an employer to provide employees with (1) a reasonable break time to express breast milk for her child for 1 year after the child's birth each time such employee has a need to express milk; and (2) a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public which may be used by the employee to express breast milk. While subsection (r) applies only to employees who are subject to section 7, which sets forth the FLSA overtime pay provisions, the rationale for the policy contained in that section applies to all executive branch employees. In accordance with the authority delegated to OPM by the President on December 20, 2010, and in order to ensure consistent treatment of nursing mothers within the Federal workforce, agencies should also apply the requirements of subsection 7(r) of the FLSA to Executive branch civilian employees who are exempt from section 7 of the FLSA. For more guidance on the implementation of this policy, please review OPM's Guide to Establishing a Federal Nursing Mother’s Program and Memo on Nursing Mothers in Federal Employment.
Public Access Defibrillation (PAD) Program
Federal agencies electing to establish a Public Access Defibrillation (PAD) program in a Federal facility should consult the guidelines contained in Federal Register FMR Bulletin 09-B2 "Guidelines for Public Access Defibrillation Programs in Federal Facilities." These guidelines were produced collaboratively by the General Services Administration and the Department of Health and Human Services and provide a basis of knowledge for Federal agencies as they implement a PAD program.
There is no law requiring installation of automated external defibrillators (AEDs) in Federal facilities. However, AED availability is becoming the standard of care for facilities, grounds, and venues with large populations. An AED is an electronic device that can automatically terminate an erratic heartbeat that would otherwise lead to cardiac arrest, restoring normal cardiac function with an electric shock. AEDs enable minimally trained personnel to safely restore a victim's heart from ventricular fibrillation (an erratic and ineffective heart rhythm) to the victim's previous electrical activity, and in turn, effective pumping activity.
AEDs are designed and intended for use by emergency medical technicians, police, firefighters, and other responders (including trained lay responders). Administration of a PAD program must include periodic training of personnel who may respond to a cardiac emergency with an AED. At a minimum, current certifications should be maintained in Cardiopulmonary Resuscitation (CPR) with AED. Medical oversight is an essential component of PAD programs.
AEDs and medical oversight services are commercially available through many sources. Federal agencies also have the option to use purchasing mechanisms allowed by the Federal Acquisition Regulation, which may include such options as the GSA Schedule (www.gsaadvantage.gov). AEDs may be purchased through an interagency agreement process like that offered by HHS-Federal Occupational Health (www.foh.hhs.gov).
Upon implementation of an AED program, a Federal agency may be required to follow various local laws. Each agency should consult its legal counsel to ensure proper compliance.
Screening Programs
Screenings are critical to individual employees and to agencies’ health promotion efforts. A screening can save an employee’s life. For agencies, collectively assessing your workforce’s screening data can help you to strategically design a worksite health and wellness program that addresses the most prominent health risk factors in your workforce; this makes screenings an essential element of realizing positive impacts on health care costs, productivity, reduced absenteeism, recruitment, retention, culture, and employee morale. Even more broadly, agencies, employees, their families, and communities all benefit from the prevention of disease.
According to the Centers for Disease Control and Prevention (CDC), administering an assessment to define employee health risks and concerns and to describe current health promotion activities, capacity and needs is the first step in the systematic process of building a successful workplace health and wellness program. Information from assessments will inform determining goals, selecting priority interventions, building an organizational infrastructure, implementing programs, and evaluating health promotion efforts.
Screening ideas to consider include:
- Conducting an employee needs and interests assessment for planning health promotion activities
- Conducting employee health risk appraisals/assessments and provide individual feedback plus health education
- Providing screenings (beyond self-report) followed by directed feedback and clinical referral when appropriate for:
- Cholesterol
- Pre-diabetes and diabetes
- Physical Assessments
- Body Composition Measurement
- Mental Health
- Substance Abuse
- Osteoporosis
- Blood Pressure
- Sun Damage
Health Risk Appraisal (HRA) or Health Assessment (HA)
A Health Risk Appraisal (HRA) or Health Assessment (HA) is a tool that helps identify risks within a population, monitor progress of those at risk or seeking improvements in their health through interventions, and track and analyze population health trends over time. The tool may simply ask general questions about lifestyle behaviors, such as physical activity levels and types, fruit and vegetable consumption, and tobacco and alcohol use. The HRA may ask more probing questions about seat belt use, sun exposure, symptoms of depression, use of age/gender-appropriate clinical preventive services, routine physicals and dental visits, real or perceived sources of health or safety risks from the workplace, and any work-associated or organizational stress affecting health of workers. Biometric testing may also be part of an HRA.
An HRA can be the single point of entry to an agency worksite health promotion program and serve as a participation tracking tool. Feedback should be given to the individual employee immediately upon completion of an HRA (such as an online HRA) or during an individual coaching session. The HRA can be a useful programming/needs assessment tool for agency representatives, provided proper procedures for protecting personal information are strictly followed, and a representative sample is collected in order to draw sound conclusions at the agency level.
Biometric Testing
Biometric testing can be included in an HRA. Biometric testing in worksite health & wellness programs is used to screen for potential medical concerns rather than for diagnosis or treatment of a medical condition. Biometric testing includes measurements for:
- total cholesterol
- high-density lipoprotein cholesterol
- low-density lipoprotein cholesterol
- triglycerides
- blood glucose (or HgbA1c)
- blood pressure
- Body Mass Index and/or waist-to-hip ratio
FEHB Preventive Healthcare
All FEHB plans cover HRAs, biometric testing, and immunizations plus over 70 preventive services with no out of pocket costs. If this approach is taken, agencies can get employees screened at no extra cost, employees learn how to get similar services for their family members, and results get back to the employee’s physician for any follow up that is needed. Many plans are even offering incentives for completion of HRAs and/or biometric testing. Agency worksite health & wellness coordinators should work with their agency benefits officers to promote these FEHB services and encourage employees to understand their specific plans, because there may be limits to networks and frequency. Preventive services that have a rating of A or B from the U.S. Preventive Services Task Force are covered by FEHB plans. You can see the complete list here: http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm.
On-site Health Clinics
Onsite health clinics can provide convenient access to high quality preventive healthcare. A variety of services can be offered at agencies, such as biometric screenings, primary care, health coaching, disease management, occupational health, and more! These services are intended to reduce agency costs, improve employee health, increase productivity, and reduce long-term risk.
Health Fairs & Special Events
Workplace health fairs are a great way to educate employees about health services available to them and the value of participating in preventive healthcare, such as screenings. Health fairs can include exhibitors from FEHB providers and various offices within your agency that have an interest in employee health (e.g., safety department, food service, Flexible Spending Accounts, Employee Assistance Programs, etc.). Agencies may also leverage external resources, including community organizations and universities. The best health fairs have a variety of activities, such as, but not limited to:
- Screenings
- Educational Information
- Chair Massages
- Yoga
- Healthy Cooking Demos
- First Aid
- Ergonomics
Workplace Health Screenings Fact Sheets
These fact sheets include the business case for screenings, descriptions of HRAs & biometric tests, implementation tips, and special considerations:
- Workplace Health Screenings
- Common Screenings
- How to Conduct Screenings
- Considerations for Screenings
Integration into Organizational Structure
The longevity of worksite health promotion programs is related to the degree that health promotion is integrated into an organization’s structure. Successful worksite health promotion programs are designed to help achieve organizational goals and have the support of top management. At a minimum, having dedicated staff, an office and budget are essential aspects of integration into the organization’s structure. Worksite health promotion must also have well-designed programs that attract and retain participants.
Considering the answers to several questions will help to create and measure the integration of a worksite health promotion program into an agency’s organizational structure:
- Is there a comprehensive health and wellness policy?
- Is there a champion(s) who is a strong advocate for the worksite health and wellness program?
- Is there a paid worksite health and wellness coordinator whose job (either part-time or full-time) is to implement a worksite health and wellness program?
- Is there an active worksite health and wellness committee?
- Is senior leadership briefed on worksite health and wellness programs and services?
- Are annual organizational objectives for health promotion set?
- Are references to improving or maintaining employee health included in the business objectives or organizational mission statement?
- Does your program engage in other health initiatives throughout the community and support employee participation and volunteer efforts?
- Is a budget or dedicated funding assigned for the worksite health and wellness program?
- Are managers trained on the value of worksite health and wellness programs?
- Are some worksite health and wellness programs and education materials tailored to the language, literacy levels, culture, or readiness to change of various segments of the workforce?
- Is there a policy that allows employees to use flexible scheduling or excused absence to participate in worksite health and wellness activities?
- Is an employee needs and interests assessment for planning health promotion activities conducted?
- Are employee health risk appraisals/assessments through vendors, on-site staff, or health plans conducted, and are individual feedback plus health education provided?
- Are all levels of management involved in the implementation of worksite health and wellness?
- Is there an official communications process or strategy to promote and market worksite health and wellness programs to employees?
- Are incentives provided, used, and/or combined with other strategies to increase participation and engagement in worksite health and wellness programs?
- Are any worksite health and wellness programs available to family members?
- Are competitions used when combined with additional interventions to support employees making behavior changes?
- Are examples of employee health-related “success stories” used in the marketing materials?
- Is data systematically gathered to evaluate worksite health and wellness programs?
It is an agency's responsibility to assure that programs are safe, appropriate, and meet legal and ethical requirements. It is advisable to negotiate or consult with unions, as appropriate, on providing services for bargaining unit employees.
Wellness Council and Committees
A wellness council or committee brings representatives from various offices to integrate services, coordinate, and promote programs. The primary goals of the council and/or committee are to encourage healthy behaviors at the worksite, advocate policy change, and create health-friendly work environments. A wellness committee should be comprised of employees who represent a cross section of the employee population. Multiple committees may be necessary, depending on the size and number of locations of the agency.
Committee Member Responsibilities
Committees should elect a wellness chair or co-chairs to conduct meetings and lead activities. Time commitments will depend on the size of the agency, depth and breadth of the services, and selected delivery option. Planning and implementation of the agency’s strategic wellness plan typically takes the most concentrated amount of time. As appropriate, these activities should be included in an employee’s work plan.
Designated wellness leaders at the management level with direct access to the agency head are recommended to be involved with wellness committees and programs. In collaboration with management and employees, the individual(s) responsible for creating a worksite health promotion infrastructure oversees the development and implementation of employee wellness policies and committees and provides ongoing assessment/monitoring of the effectiveness of the worksite health & wellness program.
Worksite Health Promotion Program Implementation/Improvement Plan Guidance
- Describe the gaps in services based on a needs assessment
- Describe existing and potential barriers to and opportunities for improvement (e.g., existing processes, systems, partnerships)
- Describe changes the agency can make to improve on gaps in services
- Define success upon completion of action steps (i.e., what constitutes improvement or achievement of the desired outcome?):
- Describe each specific step/task that needs to occur to achieve the desired outcome
- Describe each product or output
- Develop a program calendar
- Develop an ongoing evaluation process
- Revise and improve the program
Set a realistic timeframe (timeline) for the completion of each step/task. Indicate dates for progress updates. Identify key stakeholders accountable for completion of each step/task.
Leave and Workplace Flexibilities
The Federal personnel system provides employees considerable flexibility in scheduling their hours of work and taking time off for routine medical examinations and preventive screenings. Agencies should review policies and make maximum use of existing work schedules to encourage employees to take advantage of preventive health services.
Alternative Work Schedules & Leave
- Alternative Work Schedules: Flexible or compressed work schedules, collectively referred to as "alternative work schedules," allow for a variety of working arrangements tailored to individual employee needs.
- Annual Leave: An employee may use annual leave for any purpose, including activities that promote wellness. An employee has a right to take annual leave, subject to the right of the supervisor to schedule the time at which annual leave may be taken.
- Sick Leave: Sick leave is a paid absence from duty. An employee is entitled to use sick leave for many purposes, including activities to promote wellness, such as routine medical, dental, or optical examination or treatment.
- Advanced Leave: An agency may, but is not required to, advance annual and/or sick leave to those employees who do not have sufficient paid leave available for health services, examinations, and follow-up treatments.
- Serious health condition or medical emergency. When an employee needs additional medical attention, e.g., for a serious health condition or medical emergency identified by a screening process, additional leave programs are available.
- Sick Leave for a Serious Health Condition. An employee can use unlimited amounts of sick leave for his or her own serious health condition.
- The Family and Medical Leave Act of 1993 (FMLA). Under the FMLA, an employee is entitled to a total of 12 work weeks of unpaid leave during any 12-month period for certain family and medical needs, including an employee's serious health condition. FMLA may be used intermittently and is in addition to other paid time off available to an employee. Employees may substitute sick leave, annual leave, or donated annual leave under the leave sharing programs for unpaid leave under the FMLA.
- Leave Sharing: Employees who experience a medical emergency and who exhaust their available paid leave may receive donated annual leave from other Federal employees through the voluntary leave transfer and leave bank programs. Employees may not use donated annual leave to participate in employee health programs.
Additional information on Federal leave programs may be found at OPM's website at /oca/leave/HTML/factindx.asp.
Agencies may consider granting brief periods of excused absence to employees to participate in agency-sponsored preventive health activities, such as health fairs, medical screenings, and smoking cessation and stress reduction classes.
Each department or agency has discretion to excuse employees from their duties without loss of pay or charge to leave. Excused absence should be limited to those situations in which the employee's absence, in the department's or agency's determination, is not specifically prohibited by law and satisfies one or more of the following criteria:
- The absence is directly related to the agency's mission;
- The absence is officially sponsored or sanctioned by the head of the agency;
- The absence will clearly enhance the professional development or skills of the employee in his or her current position;
- The absence is brief and is determined to be in the interest of the agency.
Ultimately, it is the responsibility of each agency head to balance support for employees' participation in health promotion activities with employees' work requirements and efficient and effective agency operations. Agencies should review their internal guidance on excused absence and applicable collective bargaining agreements.
Telework
Telework is a work arrangement that allows an employee to perform work, during any part of regular, paid hours, at an approved alternative worksite (e.g., home, telework center). It includes what is generally referred to as remote work but excludes any part of work done while on official travel or mobile work. The health benefits of telework include:
- Improvements in general health
- Reduction in adverse health effects from exposure to air pollution
- Improvements in eating habits
- More time to integrate fitness activities
- Enhanced ability to manage sick leave for preventive treatments and/or screenings
- Reduction in stress by 25 percent, on average
- Improved lactation support through greater flexibility and time to breastfeed
- Fewer employees becoming sick and fewer days of work missed
- Employees’ ability to return to work more quickly following surgery or medical issues
- Reduction in health care costs associated with doctor visits and prescriptions through reduction in spread of communicable diseases and increase in healthy behaviors
- Reduced emissions from commuting that affect air pollution and climate control
- Reduced greenhouse gas emissions from business travel, particularly by airplane
- Enhanced containment of infection during a pandemic outbreak
Sharing ways employees can use the time saved by reduced commutes for health promotion activities such as physical activity, stress management, and community and family engagement can send a powerful message. When planning health promotion activities, ask how employees who telework will be allowed to participate, such as through video conferencing, webinars, or a primary point of contact, so that teleworkers may pick up support material or equipment.
Program Branding
Branding provides instant recognition to an agency’s worksite health & wellness program and helps employees understand all of the program elements. Branding can be a logo, a motto or slogan, or image that captures the essence of the agency’s worksite health & wellness program and provides an opportunity for the agency to consistently convey a message. Concise, clear and well-planned communications use every possible customer (employee) touch point – signage, emails, voice messaging, social media, incentive items, newsletters and even telework agreements – as a branding opportunity. Many agencies offer a range of services that employees may not associate with the agency’s health promotion program. Branding helps employees make this program association, which then provides valuable feedback to the agency when employees are surveyed. Consider asking employees for branding ideas as part of a program marketing schematic and to create buy-in and excitement about a new or rejuvenated worksite health promotion program.
Linkages to Related Programs
Over the years, worksite health promotion has evolved from and integrated with other worksite programs. Some common linkages include Employee Assistance Programs (EAPs) and programs to help employees balance work and family. When linking worksite health & wellness programs to related programs, agencies may consider:
- Providing flexible work scheduling policies
- Partnering with:
- Federal Employee Health Benefits Program (FEHB)
- Federal Flexible Spending Account Program (FSAFEDS)
- Employee Assistance Program (EAP)
- Traditional occupational health and safety programs
- Telework
- Other work-life programs
- Drug Free Workplace Program
- State/local public health agency
- Health insurance plan
- Health management program and/or wellness program provider/vendor
- Workers compensation provider
- Health-related organizations
- Hospital
Federal Employees Health Benefits (FEHB) Program
The FEHB Program complements worksite wellness programs by providing coverage for preventive care, immunizations, cancer screenings, diabetes, cholesterol, osteoporosis screening and tobacco cessation resources with no cost shares. Many plans also offer diabetes screening with no co-payment, nutrition counseling, and low-cost generic medications. Cost-sharing and other plan features are applicable based on gender and age recommended services. Providers and services may be limited to in-network and/or preferred drug coverage and office visit cost sharing may apply. See specific plans for details. Completing Health Risk Assessments (HRAs) through an FEHB health plan allows health plans to identify Federal employees as candidates for case management or disease management and offer suggestions on healthy lifestyle strategies, including how to reduce or eliminate health risks. Health plans can provide tips and educational material about good health habits, as well as information about routine care that is age and gender appropriate.
Federal Flexible Spending Account Program (FSAFEDS)
Employees working for an executive branch agency or an agency that has adopted the Federal Flexible Benefits Plan ("FedFlex") may elect to participate in the Federal Flexible Spending Account Program (FSAFEDS). The only exception(s) are intermittent or “when actually employed” (WAE) employees who are expected to work less than six months in a calendar year. Under the Internal Revenue Code, annuitants (other than reemployed annuitants whose employment status is full-time) cannot participate in the FSAFEDS Program. Participating in a flexible spending account (FSA) is a way to set aside part of pre-tax wages for payment of eligible expenses. An annuity is not a wage. Military personnel are not eligible.
FSAFEDS offers three different FSAs: a health care flexible spending account, a limited expense health care flexible spending account, and a dependent care flexible spending account. An FSA is a program offered by employers that allows their employees to pay for eligible out-of-pocket health care and dependent care expenses with pre-tax wages. By using pre-tax dollars to pay for eligible preventive, secondary, and tertiary health care and dependent care expenses, an FSA gives individuals immediate discounts on these expenses that equal the taxes incurred on that expense.
- The Health Care Flexible Spending Account (HCFSA) can be used to pay for qualified medical costs and health care expenses that are not paid by their FEHB plan or any other insurance.
- The Limited Expense Health Care Flexible Spending Account (LEX HCFSA) is only available to employees who enroll in an FEHB Program under a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA). Eligible expenses are limited to dental and vision care services/products that meet the IRS definition of medical care.
- The Dependent Care FSA uses pre-tax wages to pay for eligible dependent care expenses. Eligible expenses are childcare for children under age 13, or day care for anyone who an enrollee can claim as a dependent on a Federal tax return who is physically or mentally incapable of self-care so that the enrollee (and spouse, if married) can work, look for work, or attend school full-time.
FEHB eligibility is not required to enroll in a Dependent Care FSA. However, employees may only choose one of the FSA options.
Health Savings Account (HSA)
Federal Employees paid through certain payroll offices are eligible to establish pre-tax allotments to their Health Savings Accounts (HSA). The Benefits Administration Letter 07-202 provides more information.
A Health Savings Account is a special type of savings account available to individuals who enroll in a High Deductible Health Plan (HDHP) that allows members to use pre-tax wages to pay for eligible health care expenses, much like an FSA. It is important to understand that there is a significant difference between the two accounts. An HSA requires enrollment in an HDHP and allows the rollover of funds from year-to-year — therefore, there is no risk of losing unused money. With an HCFSA, enrollees can be in any type of FEHB plan, including an HDHP, or no FEHB insurance plan. However, an HSA eliminates eligibility for a “general purpose” HCFSA, because both accounts are used to pay for the same type of expenses. Enrollees in an HDHP with an HSA are eligible for a LEX HCFSA because the LEX HCFSA pays for eligible dental and vision expenses only.
The FSAFEDS Program is separate from the FEHB HDHP and HSA option. For additional information on HDHPs and/or HSAs visit /insure/health/hsa.
Employee Assistance Program (EAP)
An EAP is a business tool used to address personal or work-related problems that may have an adverse effect on one’s performance, conduct, or well-being. Through confidential assessments, referral services, and consultations, EAPs optimize an organization’s culture and success.
EAPs provide strategic analysis, recommendations, and consultation throughout an organization to enhance its performance, culture, and business success. These enhancements are accomplished by professionally trained behavioral and/or psychological experts who apply the principles of human behavior with management, employees, and their families, as well as workplace situations to optimize the organization’s human capital.
The basic services of the EAP include:
- Confidential, free, short-term counseling to identify and assess problem(s) and to help employees in problem-solving.
- Referral, where appropriate, to a community service or professional resource that provides treatment and/or rehabilitation. With the exception of illness or injury directly resulting from employment, medical care and treatment are personal to the employee and, therefore, payment may not be made from appropriated funds unless provided for in a contract of employment or by statute or by regulation.
- Follow-up services to help an employee readjust to his or her job during and after treatment, e.g., back-to-work conferences.
- Training sessions for managers and supervisors on handling work-related problems that may be related to substance abuse or other personal and/or health-related problems.
- Orientation and educational programs to promote the services of the EAP.
- Briefings to educate management and union officials on the role of the EAP.
In addition, the EAP can be extremely important in:
- Preventing and intervening in workplace violence incidents
- Delivering critical incident stress debriefings
- Providing assistance to management and employees during agency restructuring
Leave and Workplace Flexibilities
For information regarding leave, flexible work schedules, excused absence, and telework, review the information available in the integration section here: Leave and Workplace Flexibilities section on this page above).
Related Information
- Delivery Mechanisms
- Staffing
- Health Education
- Social and Environmental Supports
- Screening Programs
- Integration into the Organizational Structure
- Linkages to Related Programs
