A note from First Cowgirl, Ann Hargis:
I am proud of the many wellness programs at OSU, but I’m especially proud of the Certified
Healthy Department program. There is strength in numbers, and when departments make the choice to
encourage each other to lead a healthier lifestyle, it speaks to the wellness commitment of our entire
system. Promoting a culture of wellness from within not only begins to positively change our campuses,
but it also makes an impact in our communities. I applaud the creative and innovative ways in which you
support each other, and I hope you will continue to seek new ways to promote a healthy, happy, and
productive work environment. Thank you for your commitment to America’s HEALTHIEST Campus® and I
look forward to celebrating even more success in 2016.
Applications are due March 11, 2016.
Certified Healthy Departments will be announced on March 21, 2016.
For questions about completing this application or Certified Healthy Departments, please contact:
Stillwater Campus and OCES: Mary Talley, Department of Wellness: mary.talley@okstate.edu Other
OSU A&M Institutions: Chief Wellness Office: chiefwellnessofficer@okstate.edu
Campus Location
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Connors State College
Langston University
Northeastern Oklahoma (NEO) A&M
Oklahoma Panhandle State University
OSU Center for Health Services
OSU Institute of Technology
OSU-Oklahoma City
OSU-Stillwater
OSU-Tulsa
County Extension Service Office
Department Information
Department Name (Department, office, school, work unit) _________________
Contact Name ___________________________________________________
Contact Address _________________________________________________
Contact Phone Number ____________________________________________
Contact Campus Email ____________________________________________
Department Supervisor Name _______________________________________
Department Supervisor Email ________________________________________
What is the size of your department?
______ Number of part-time staff
______ Number of full-time staff
______ Number of part-time faculty
______ Number of full-time faculty
______ Number of student employees
What year(s) has your department been recognized as a Certified Healthy Department?
 2011
 2012
 2013
 2014
 This is our first year to apply
Leadership Support/Culture of Wellness
Leadership is vital for a true culture of wellness. Click on the items that indicate leadership support for
wellness within the department.
 Department leader consistently articulates the value and importance of health (e.g. making the
connection between health, productivity/performance, and business results).
 Department leader regularly participates in, or encourages participation in, wellness related
programs and activities.
 Department leader is a role model for prioritizing health and work-life balance (e.g. he/she does not
send emails while on vacation; he/she takes activity breaks during the work day, etc.)
 Department leader provides health communications or in-service training to employees at least
once every year on holistic wellness topics such as:
 Alcohol and drug use
 Injury prevention
 Career development
 Managing stress
 Cultural competency
 Physical activity
 Early recognition of depression/anxiety
 Sleep management/adequate rest
 Financial readiness
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 Suicide prevention
 Healthy eating
 Tobacco
 Immunizations
 Violence prevention
Department leader actively prevents bullying, harassment, and discrimination within the workplace.
Department leader allows flexible work schedules to support work-life balance.
Department leader actively encourages employees to participate in annual preventive screenings
and immunizations, such as Catapult biometric health risk screening, or with primary care provider.
Department leader actively encourages individual participation in disease/addiction management
programs when indicated.
Department leader encourages memberships and participation in professional organizations.
Departmental leader encourages and allows time for professional development.
Department leader encourages employees to seek OSU support services such as:
 Ergonomic assessments (including proper seating, workstation adjustments to prevent injury,
improve functionality, and use built-in computer access options)
 Department of Wellness (Assistive Technology Demo Center and Short-term Loan Library of
devices/software such as AT for vision, hearing, arthritis, computer access, and ergonomic
accessories)
 Other ____________________
Tobacco Free
Although OSU was one of the first two university systems to go tobacco free, tobacco remains the
number on cause of preventable death within the state of Oklahoma. Check the tobacco use programs
that apply to your department. (Check all that apply).
 Department promotes the Oklahoma Tobacco Quit Line (800-QUIT-NOW) to employees who
currently use tobacco products.
 Other ____________________
Nutrition/Hydration
Fueling our bodies with the best fuel we can is vital! Healthy eating choices must be available and easy
to access. Check the healthy eating options that apply to your department. (Click on all that apply.)
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A water fountain or hydration station is available to the department.
Department encourages employees to hydrate with reusable water bottles.
Department provides employees with food preparation and storage facilities.
Department provides protected time and dedicated space away from work area for breaks and
lunch.
 Employees bring healthy snacks and meals on average more than 50% of the time.
 Department has a written policy or formal communication which makes healthier food and
beverage choices available during meetings when food is served.
 Department encourages employees to attend nutrition education and cooking classes.
 Department promotes utilizing healthy food options, such as a farmer's market.
 Other ____________________
Active Lifestyle
A sedentary lifestyle minimizes our creativity and prevents us from being the most productive,
personally and professionally. An active lifestyle is much more than “exercise”. Check the active
lifestyle programs that apply to your department. (Click on all that apply).
 Department encourages employees to have walking meetings.
 Department posts signs at elevators, stairwell entrances or exits and other key locations
encouraging employees to use the stairs.
 Employees participate in departmental walking groups or activity based classes.
 Activity trackers (e.g. Fitbits) are used to encourage daily physical activity through walking/jogging.
 Department encourages employees to track minutes of physical activity through Blue Cross Blue
Shield’s Well onTargetSM website (or other website).
 Alternative modes of transportation (e.g. biking, walking, and/or bus) are encouraged.
 Other ____________________
Mental Health and Well-Being
Our mental health is inextricably intertwined with who we are. Our personal and professional stressors
can sometimes take over our mental health, causing a disharmony that prevents us from being the best
we can be. Check the mental health/well-being programs and support that apply to your
department. (Click on all that apply).
 Department fosters a work environment where co-workers and supervisors are supportive of
employees' psychological and mental health concerns, and respond appropriately as needed.
 Department supports work-life harmony (e.g. with flex time or job share options).
 Department provides work-life balance/life-skills programs.
 Department provides dedicated space that is quiet where employees can engage in relaxation
activities, such as deep breathing exercises.
 Department promotes stress management through "quiet rooms", on-site relaxation classes, proper
lighting, sound reduction measures, or other techniques.
 Department provides training on early recognition of signs and symptoms of anxiety and depression.
 Department promotes and encourages employees to utilize OSU’s on-site Employee Assistance
Program, and/or ComPsych, OSU’s enhanced employee assistance program.
 Department provides resources for personal/addiction issues including, but not limited to, alcohol
and/or prescription drug use/misuse, other substance use/abuse, gambling, or domestic violence.
 Employees participate in financial well-being programs.
 Department encourages employees to get adequate amounts of sleep.
 Department has a policy limiting hours that work-related emails will be sent (e.g. between 7:00 p.m.
- 7:00 a.m. weekdays and on weekends.).
 Department provides opportunities for employee participation in organizational decisions regarding
workplace issues that affect job stress.
 Other ____________________
Culture of Wellness and Environmental Safety
A safe environment and an attitude of wellness are imperative for a true culture of wellness. (Check all
that apply.)
 Employee health and well-being are included in department's goals and value statements.
 Department has dedicated bulletin boards, stairwell signs, displays, and/ or electronic displays that
promote the health/wellness programs and activities.
 Department engages in group wellness activities such as wellness walks, intramural sports,
community and service learning opportunities.
 Department has an active recycling program (with multiple, easily visible containers).
 Healthy vending and snack options are available, at equitable prices.
 Physical activity is explicitly encouraged by features or resources in the work environment (activity
breaks, walk and talk meetings, standing work stations).
 Department encourages and supports employee participation in community health initiatives and
volunteer efforts (e.g. blood drives, United Way, etc.).
 Department encourages management of chronic health conditions (e.g. hypertension, diabetes,
hypercholesterolemia).
 Department provides blood pressure monitoring devices available with instructions for employees
to conduct their own self-assessments.
 Department provides family, unisex or single occupancy bathroom facilities.
 Department provides signage in bathroom to encourage hand washing.
 Safety is a priority within the environment (e.g. ergonomic design, lighting, safety rails, etc.).
 Department staff receives quarterly training regarding safety-related topics, policies, and
procedures.
 Department has a written plan for emergency response to medical events within the department
(such as heart attack or stroke).
 Department has at least one employee trained in CPR, AED, and First Aid.
 Department provides opportunities for employee input on workplace hazards and solutions.
 Department has written policy and procedures for reporting injuries and near misses.
 Department has a program to investigate the causes of injuries or illnesses.
 Department has an active wellness committee.
 Other ____________________
AHC Innovator
Each department needs a wellness champion. This person relays health and well-being information to
departmental employees, and assists the department with its own wellness goals and initiatives. Does
your department have a designated wellness champion/coordinator?
Click here for more information and dates of future AHC Innovator training.
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Yes- designated AHC Innovator.
Yes- designated wellness coordinator.
Yes- informal wellness champion.
No- we will recruit one.
Miscellaneous
Each department is different and has different missions, goals, and priorities, please list your top three
wellness priorities:
Item 1
Item 2
Item 3
What do you feel are the greatest challenges you and your colleagues encounter in your efforts to make
healthy lifestyle choices at work?
Item 1
Item 2
Item 3
New FOR 2016!! HEALTHY DEPARTMENT GRANT APPLICATION (OPTIONAL). As part of America’s
Healthiest Campus®, the Chief Wellness Office is launching grants designed to support innovative
departments in their efforts to provide fun and creative wellness initiatives in their area. The Chief
Wellness Office will award a limited number of $250 grants. If your department has an inspiring idea to
enhance a culture of health and well-being within your department, complete the following four
questions (in 150 words or less for each section).
Click to write the question text
 Yes! I would like to submit a grant application.
 No, thank you.
With a $250 grant, what type of health and well-being initiative could you implement in your
department to improve your department’s culture of wellness? Be specific as to how you would use
these funds.
How might this initiative engage your co-workers?
How would you demonstrate success?
Signatures (Click on each box to "sign" each statement)
 I have completed this application to the best of my knowledge.
 I understand that my Department supervisor’s approval will be required to process the application.
Click here for Department Approval form.