Healthy Hospitals Physical Activity Scan * Required

Transcription

1 * Required 1. Rater ID * Insert here the ID# you were assigned for the project 2. Hospital ID * Insert here the ID# for the hospital you are scanning today Page 1 of 15

2 3. Hospital Name * 4. Scan Date and Scan Start Time * Example: December 15, :03 AM Stairs Evaluation Please choose the stairs closest and/or most visible to the main entrance to answer the following questions. 5. Staircase is openly visible Does t Apply 6. Able to see stairs from entrance Does t Apply 7. Carpeted Does t Apply 8. Is there music playing Does t Apply Page 2 of 15

3 9. Walls painted decorated or artwork Does t Apply 10. Utilities visible in stairwell e.g., pipes, wires showing 11. Doors to stairs are unlocked on most or all floors Does t Apply 12. Door leading to stairs marked "stairs" (not just "exit") Does t Apply 13. Warnings or caution signs on door(s) Does t Apply 14. Floor number labeled inside of stairway Does t Apply Page 3 of 15

4 15. Restricted exit (e.g. locked from inside) Does t Apply 16. Designated as stairs for employees/staff only Does t Apply 17. How many signs encouraging stair use did you see? ne 1 sign 2-3 signs more than 3 signs 18. Comments Grounds and Physical Activity Centers Which of the following items are present on the grounds? 19. Courts/Fields for sports Page 4 of 15

5 20. Marked walking path on or adjacent to grounds 21. Open space/grassy area large enough for physical activity 22. FOR ITEMS ABOVE Are they in a safe place?, most areas 23. Are they well lit?, most areas 24. Is there a fitness center/area? After the last question in this section, skip to question 52. Unable to access 25. Hours of operation Open anytime between 5am and 8am? 26. Open between 8am and 9pm? Page 5 of 15

6 27. Open anytime between 9pm and Midnight? 28. Comments: 29. Open to visitors/patient referrals? 30. Cardio Machines (e.g. treadmills, ellipticals, bikes, stepping, & rowing machines)? 31. Total number of cardio machines? 32. Strength equipment 33. Total number of strength equipment? Page 6 of 15

7 34. Free weights 35. Total number of free weights? 36. Area for aerobics/dance/other activities 37. TV in the workout area 38. Music in the workout area 39. Equipment is in good condition (i.e., fairly new, clean, comfortable) 40. The fitness center is an inviting environment (i.e. enough space, comfortable temperature and lighting) Page 7 of 15

8 41. Are the following available near or inside the gym area? Changing rooms 42. Showers 43. Scales 44. Are the scales in good condition (e.g., fairly new, clean, comfortable)? 45. Are the showers in good condition (e.g., fairly new, clean, comfortable)? Page 8 of 15

9 46. Are the changing rooms in good condition (e.g., fairly new, clean, comfortable)? 47. Are the changing rooms easily accessible? 48. Are the showers easily accessible? 49. Are the scales easily accessible? 50. Please comment on signage and promotions: Number of signs encouraging one to join physical activity classes, notices about onsite/off site exercise classes, site/campus maps illustrating places to be active, etc. ne More than 3 signs Page 9 of 15

10 51. Please comment on signage and promotions: Are there other promotion programs for physical activity through classes or using walking trails (on-campus or in the community)? E.g., employee intranet promotions, patient handouts? Transportation/Parking Assessment Transportation 52. Are facilities (bike locks, bike racks) for bikes present? Please indicate # of slots in the other box Other: 53. Number of bikes parked in bike rack(s) ne 1-2 bikes Half-filled with bikes More than half-filled with bikeks 54. How long is the distance between the parking lot and the worksite? Please offer comments in the Other box Less than 5 minutes walking 5-10 minutes walking More than 10 minutes walking Page 10 of 15

11 55. Is public transit access available near the hospital? 56. Number of signs in parking lot/or building encouraging drivers to park farther away and walk ne 1 sign 2-3 signs more than 3 signs 57. Number of signs encouraging bike/walk to work, vanpool programs, public transportation programs ne 1 sign 2-3 signs >3 signs 58. Are there other strategies to promote biking or walking to the hospital? (e.g., employee intranet promotions or patient handouts?) Please offer comments in the Other box Walkability Assessment For each of the following categories describing the walkability of the hospital campus, choose the appropriate descriptor. Page 11 of 15

12 59. Pedestrian Facilities: presence of a suitable walking surface, such as a sidewalk or path. permanent facilities; pedestrians walk in roadway or on dirt path Sidewalk on one side of road; minor discontinuities that present no real obstacle to passage Continuous sidewalk on both sides of road, or completely away from roads 60. Pedestrian Conflicts: potential for conflict with motor vehicle traffic due to driveway and loading dock crossings, speed and volume of traffic, large intersections, low pedestrian visibility for walking and mobility impaired pedestrians. Check all that apply. High conflict potential Medium conflict potential Low conflict potential 61. Crosswalks: presence and visibility of crosswalks on roads intersecting the segment. Traffic signals meet pedestrian needs with separate walk lights that provide sufficient crossing time. Check all that apply. Crosswalks not present despite major intersections Some crosswalks present, or few intersections intersections, or crosswalks clearly marked 62. Maintenance: cracking, buckling, overgrown vegetation, standing water, etc. on or near walking path. Does not include temporary deficiencies likely to soon be resolved (e.g. tall grass). Major or frequent problems Some problems problems 63. Path Size: measure of useful path width, accounting for barriers to passage along pathway. permanent facilities At least 3 feet wide, some barriers More than 5 feet wide, barrier free Page 12 of 15

13 64. Buffer: space separating path from adjacent roadway. buffer from roadway Less than 3 feet from roadway t adjacent to roadway 65. Aesthetics: includes proximity of construction zones, fences, buildings, noise pollution, quality of landscaping, and pedestrian-oriented features, such as benches and water fountains. Uninviting Medium Pleasant 66. General Impressions and Other Comments Related to the Community, Connectivity, and/or Walkability Assessment: Wellness Program Assessment 67. Is there a wellness program at this hospital? Comment on physical activity aspects of the wellness program at hospital (e.g. classes offered/promoted, tracking PA through pedometers) Don't Know 68. Does the worksite have a written policy statement supporting employee physical fitness? Don't Know Page 13 of 15

14 69. Does the worksite provide any type of incentives for engaging in physical activity? Don't Know 70. Does the worksite provided exercise/physical fitness specific messages to the general employee population on a regular basis? Don't Know 71. Does the worksite organize or sponsor a lunch time/after work walking club Don't Know 72. Is there paid physical activity time? Don't Know 73. tes Offer any comments from today's scan 74. End Time * Enter the time when you finished the scan Example: December 15 11:03 AM Page 14 of 15

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