Dear

Respondent, Thank you very much for agreeing to answer this survey. This questionnaire includes questions about you and your habits, health-related practices, health knowledge, and attitudes. We know that several answers you will share are very private. We assure you that the information obtained from you shall be treated as CONFIDENTIAL. To maintain your anonymity, we will never ask you for your name or any information that will identify who you are such as your home address or contact numbers. Sincerely Yours, International Labour Organization

START: _______ | END: _______ INSTRUCTIONS: Read each question carefully. Mark your answer in the square next to the question with an X. Mark one answer for each question; unless the instruction says to mark more than one answer. To open-ended questions, please write your answer legibly. A. Health and Nutrition A1. What is your height? _____/ _____ (feet and inches) A2. What is your weight? __ lbs OR ___kg A3. Are you aware of any company policy on health promotion specifically on healthy diet/food choices? A4. Are you aware of any company program for health promotion specifically on healthy diet/food choices? A5. Are you aware of any services available at your workplace promoting healthy diet/food choices? A6. Where do you get information about workplace policies, programs and services related to healthy diet /food choices? A7. What sources of information on workplace policies, programs and services related to healthy diet/food choices do you prefer? Yes No

Yes

No

Yes

No

Company Personal interactions Internet SMS (text messages) Brochures Flyers Posters Books Bulletins Others (please specify) ____________________________ Company Personal interactions Internet SMS (text messages) Brochures Flyers Posters
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Books Bulletins Others (please specify) ___________________________ A8. Are you eating more, moderately, or less of these foods? Rate your intake in relation to your intake of food from the other food groups specified below. (tick one box per food group) More Mod Less Not Sure Vegetables Sugary foods Meat Starchy foods Fatty foods Fruit Salty foods Processed snacks (chips) Tick the health problem(s) that you think is/are related to each of the following: A9. Low intake of fruit and vegetables Stroke Cardiovascular diseases Cancer None of the above Dont know A10. High intake of sugar Hypertension Diabetes Asthma None of the above Dont know A11. High intake of sodium or salt Hypertension Diabetes Kidney stones None of the above Dont know A12. High intake of fat Cancer Diabetes Cardiovascular disease None of the above
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Dont know B. Physical Activity B1. Are you aware of any company policy on health promotion specifically on physical activity? B2. Are you aware of any company program related to sports/fitness/recreational activities? B3. Do you do any vigorous-intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate (like running/jogging) for at least 15 minutes continuously? B4. Do you do any moderate-intensity sports, fitness or recreational (leisure) activities that cause large increases in breathing or heart rate (like walking) for at least 30 minutes continuously? B5. How much time do you usually spend sitting on a typical working day? B6. How long is your total break from work? (not including lunch) B7. What do you do on this break? (check all that apply)

Yes Yes

No No

Once a week

2x a week

3x-4x a week

5x - 7x a week

Dont do this exercise

Once a week

2x a week

3x-4x a week

5x - 7x a week

Dont do this exercise

______ hours : _____ minutes less than 15 minutes 15 minutes 16-30 minutes Toilet break Eat Stretch Smoke Walk outside the building Chat with colleagues Others (specify) __________________________ Too tired Long working hours Personal commitments Family commitments Too lazy Not sure of what to do Unsure of local facilities Not interested Costs associated with physical
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B8. In your opinion, which of the following factors currently limit your ability to undertake regular physical activity? (check all that apply)

activity Dont see how it would benefit me None Opportunity for physical activity is not offered by the company Others (specify) __________________________ B9. Complete the statement: I would participate Gym membership in the following if made available through my Sports fest work Activity club (check all that apply) (basketball, badminton, etc.) Runners/Marathon group Others (specify) _________________________ B10. What leisure activities you do after work? Go to the theater or cinema Watch TV (check all that apply) Sleep Play sports (please specify)
________________________________

Surf the Internet or play online games Go out with friends Stay home Others

___________________________

C. Alcohol C1. Are you aware of any company policies about alcohol consumption? C2. As far as you know, which of the following programs/services related to alcohol use does your company provide? (check all that apply) C3. How would you best describe yourself?

Yes

No

Counseling Leaflets Health training Advice Referral to addiction specialist None Others (specify) ____________________________ I am a non-drinker (go to D1)
5

(choose one)

I only drink during special occasions I am an ex-drinker (go to D1) I am a drinker trying to quit I am a drinker
Never Once a month or less 2 to 4 times a month 2 or more times per week Daily

C4. How often do you drink the following alcoholic beverages? a. Beer b. Wine c. Cocktails d. Hard drinks (e.g. brandy) C5. On the average, how much of the following alcoholic beverages do you usually consume? a. b. c. d. Beer (bottle) Wine (wine glass) Cocktails (cocktail glass) Hard drinks (shot)

Not Applicable

1 or 2

3 or 4 5 or 6

10 or more

7 to 9

C6. Tick the health problem/s that you think are related to excessive consumption of alcohol 2. a. C7. Are you considering reducing your alcohol consumption? C8. What type of support would you consider using to reduce alcohol consumption? (check all that apply) Smoking D. D1. Are you aware of any company policy against smoking? D2. Are you aware of any company programs or services offered to help employees quit smoking?

Cancer Hypertension Pancreatitis Depressive disorder Cirrhosis None of the above

Yes No Not now Not applicable

Alcoholics Anonymous Hypnotherapy Group cessation program Self-help materials Addiction counseling None of the above Yes Yes No No

D3. In your company, employees are

Not allowed to smoke inside and outside the workplace Restricted to smoke at certain areas outside Allowed to smoke at certain areas outside and designated areas inside I am a non-smoker (go to D5, then E1) I am an occasional smoker I am an ex-smoker (go to D5, then E1) I am a smoker trying to quit I am a smoker Frequently exposed Moderately exposed Hardly exposed Not exposed

D4. How would you best describe yourself? (Choose one)

D5. How often are you exposed to second-hand smoke?

D6. On the average, how many sticks do you smoke per day? D7. Are you considering quitting smoking? D8. What type of support would you consider using if you attempt to quit?

___ number of sticks

N/A

Yes

No

Not now

Not applicable

D9. If your workplace would become smoke-free indoors and outdoors, how likely would you seriously consider quitting smoking? D10. Would you participate in a smoking cessation assistance program if the company

Self-help Group cessation program Doctors advice Use of nicotine gum/patch Addiction counseling None of the above Others (specify) ___________________________ Definitely Very likely Somewhat likely Not at all Yes No

would offer one?

Not sure (please explain) ____________________________

E. Use of Drugs (OPTIONAL) YOU MAY SKIP THIS PART IF YOU FEEL UNCOMFORTABLE. OTHERWISE, PLEASE ANSWER ALL ITEMS TRUTHFULLY. No E1. Are you aware of any company policy on drug Yes abuse prevention? E2. Did you sign a form to acknowledge that you were notified of this policy? E3. Which of the following programs and services related to controlling drug addiction are made available to employees by the company? (check all that apply) Yes No N/A

Counseling Leaflets Health Seminars Advice Referral to addiction specialist None of the above Others (specify) ___________________________

E4. How would you best describe yourself? (Choose one)

Ive never used drugs (go to F1) I once tried using drugs I am an occasional drug user I am a drug user I am a recovered drug user Within the past month Within the past 12 months

E5. Which of the following prohibited drugs are you taking/have you taken? Marijuana Shabu Cocaine Valium Ecstasy Injectables/intravenous drugs Others (specify) _________________________________ E6. I take drugs to

Cope with job stress Cope with negative emotions Cope with negative emotions Celebrate a happy event Keep myself awake Bond with friends
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Others (specify) __________________________ F. Tuberculosis F1. Are you aware of any company program or service for employees who are diagnosed with Tuberculosis (TB)? F2. Which of the following services are available in your company? (check all that apply)

Yes

No

Trained staff that can provide information on TB Educational materials on TB Collaboration with other organizations to address TB Diagnosis/ treatment of TB Others (specify) ___________________________ None Yes No
(go to F5)

F3. Have you been tested for tuberculosis in the past twelve months? F4. Has any member of your household been diagnosed to have TB in the last twelve months F5. What do you think causes TB? (check all that apply) F6. What do you think is the most common sign/symptom of TB?

Yes

No

Microbes/ Germs/ Bacteria Smoking Malnutrition Fatigue Dont know Coughing with sputum Blood in sputum Pain in chest or back Dont know Through the air when coughing Sharing utensils Touching a person with TB Sexual contact Dont know Yes No Not sure
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F7. How do you think is TB spread? (check all that apply)

F8. Would you socialize with a person diagnosed with TB?

G. Sexually Transmitted Infection (STI, formerly known as Sexually Transmitted Disease or STD) and Human Immunodeficiency Virus (HIV) G1. Are you aware of any company awareness Yes, both program on STI (also known as STD) and HIV? STI only HIV only None Dont know G2. Which of your companys program have you joined, participated in, or received? STI HIV (check for each STI and/or HIV program) a. Talks/Seminars b. Referral to Testing and Counseling c. Condom distribution d. Distribution of educational materials e. No program offered in the company G3. With whom are you most comfortable to discuss HIV/STI: (check all that apply) Co-workers Friends (same sex) Friends (opposite sex) A family member (e.g. brother, sister, parent, etc.) e. Partner (romantic partner/sexual partner) f. A medical doctor/ nurse/ health professional g. Company nurse h. HIV/AIDS counselor i. HR j. Others (specify) ______________________________ k. No one G4. Where do you get information about STI and HIV? (check all that apply) a. Books and textbooks b. Internet c. Newspapers and magazines d. TV a. b. c. d. STI STI HIV HIV
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Movies Radio Flyers and brochures Comics Medical professionals Other people Others (specify) ____________________________ G5. Are you aware of any company policy on hiring, non-discrimination, treatment, and care of employees with STI and HIV? (If yes, go to G6; If no, go to G7) G6. Which type of company policies on STI and HIV are you aware of?

e. f. g. h. i. j. k.

STI Yes No STI Hiring Non- discrimination Treatment and care Others ___________ STI Yes Yes Yes No No No Yes Yes Yes No No Yes No

HIV

HIV Hiring Non-discrimination Treatment and care Others ______________ HIV No No No N/A N/A

G7. Do you know where to go for STI and HIV services/ testing? a. Prevention b. Treatment c. Testing G8. Do you regularly use a condom when having d. sex? G9. The last time you had sex, did you use a condom? G10. If you answered No to G8 and/or G9, please tick the reasons that apply. (check all that apply)

Yes (go to G15) Yes (go to G15)

(go to G14)

(go to G14)

I/my partner did not think it was needed I was with my girlfriend/boyfriend and thought it was safe I/my partner wanted to have sex right away There was no condom available I/my partner did not want to
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G11. Can you get a condom every time you need one? G12. If you answered No to G11, please tick the reasons that apply. (check all that apply)

use a condom Others (specify) ____________________________ Yes No

It costs too much Shop/drugstore is too far away Shop/drugstore is closed I feel ashamed to buy a condom I dont know where to buy a condom I dont have time to buy a condom Others (specify) ___________________________ G13. Where do you usually get a condom? (check Store all that apply) Drugstore Hospital Clinic Friends Co-workers Others (specify) ___________________________ G14. If you thought you would be potentially at Definitely yes risk, would you refuse to have sex without a Maybe yes condom? Not sure Maybe no Definitely no Not applicable STI G15. What do you think are the symptoms of STIs? (check all that apply) No physical symptoms Itching in the genital area Penile/vaginal discharge Feeling of weakness/getting sickly Painful urination Sores in the genital area or sexual organ Abdominal pain Body sores
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G16. If you ever experience any of the STI symptoms, would you know where to go? G17. If you wanted more information on/or need Surf the Internet treatment for STIs, what would you do? Call a hotline/helpline (check all that apply) Self-medicate using medicines Self-medicate using alternative methods Consult a friend Consult a doctor/health professional Others (specify) ____________________________ G18. If you were to go a health professional for Hospital treatment, where would you go? Office clinic Other private clinic Social hygiene clinic Barangay health center Others (specify) ____________________________ Yes No Not sure

Foul smelling discharge Swellings in the groin area Yes No

G19. Would you socialize with a person diagnosed with STI? HIV G20. From what you know about HIV, do you agree with the statements below? a. Having sex with one and faithful partner reduces the risk of HIV transmission. (Mutual monogamy) b. One can get HIV from using public toilets. c. Using condom during sex prevents HIV transmission. d. A person can get HIV infection from mosquito and other insect bite. e. Sharing needles when injecting drugs will

Yes Yes Yes Yes Yes No No No No No Dont know Dont know Dont know Dont know Dont know
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increase the risk of HIV infection f. Abstinence from sex prevents HIV transmission. g. There is no cure for AIDS. G21. How worried are you that you might get HIV? G22. Have you ever had an HIV test? G23. Did you get the result of this test? G24. How do you rate your risk for HIV?

Yes Yes

No No

Dont know Dont know

Very much Somewhat A little Not at all Yes Yes

No No

No risk (go to G26) Low risk Moderate risk High risk G25. Why do you feel that you are at risk for Because I often change sex HIV? (check all that apply) partners Because I dont always use a condom Because I share needles when I inject drugs Others (specify) ____________________________ G26. Why do you feel that you are not at risk for Because I only have one sex HIV infection? (check all that apply) partner Because I always use condom Because I have never injected drugs Because Im convinced my partner/s is/are not infected Because I dont do anal sex Because I never/rarely have sex Others (specify) ____________________________ G27. Companies should not hire applicants who Agree Disagree Not sure are HIV positive.
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G28. Current employees who test positive for HIV should be terminated. H. Breastfeeding H1. Are you aware of any company policy on breastfeeding? H2. Do you know of any company awareness program on breastfeeding? H3. Did you want to breastfeed your baby after he/she was born? H4. Do you have a lactation room/facility within your company? H5. How would you rate your companys lactation room/facility? a. Space b. Accessibility c. Facilities

Agree

Disagree

Not sure

Yes Yes Yes

No No No
Not Applicable

Yes

No

Dont know

(go to H6)

Not Applicable (go to H6)

Very Good

Good

Poor

I dont know

H6. Does your company have a breastfeeding break? H7. Do you use the breastfeeding break? H8. If you answered no, why not?

Yes

(go to H9)

No No

(go to H8)

Not applicable (go to H9) I think my boss might disagree with it I dont think my colleagues will cover for me I dont feel the need to use it Others (specify) ____________________________ Yes
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Not applicable H9. Would your colleagues be willing to support Most of them would be willing Some would be willing breastfeeding mothers? (such as substitute the mothers work when she leaves to pump Most of them would not be willing I dont know if they would be willing breast milk, take the night shift, etc. or not H10. Do y ou a gree t hat m others s hould b e a ble Yes No Depends on the to express their breast milk at the workplace? situation I. Personal Demographics I1. Gender Male Female I2. Age ____ years old I3. Educational attainment High School graduate Undergraduate Associate Degree College graduate MA/Graduate level PhD graduate Others (specify) ____________________________ I4. Religion Roman Catholic Christian Protestant Muslim None Others (specify) ____________________________ I5. Civil status Single Married Unmarried Separated Annulled Widow/widower I6. Sexual preference Male only Female only Male and female None Undecided
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Others (specify) ____________________________ I7. Relationship status Single (not dating) Single (dating) In a relationship with opposite sex In a casual sexual relationship with opposite sex In a relationship with same sex In a casual sexual relationship with same sex In relationships with both sexes In casual relationships with both sexes Others (specify) ____________________________ Inbound voice Outbound voice Both inbound and outbound voice Back office processes Knowledge processes Transcription Software development and services Entry-level Team leader/supervisor Manager _____ years _____ months Cell phone Laptop Music players Tablets Netbooks Others (specify) ___________________________ Facebook
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I8. Primary responsibility

I9. Primary role

I10. How long have you been working for the same employer? I11. Gadgets you own. (check all that apply) I12. Social networking sites you frequently visit.


(check all that apply)

I13. Living arrangement

I14. Where do you usually hang out if time permits? (check all that apply)

Twitter Tumblr Google+ Chat sites YouTube Multiply MySpace Downelink Planet Romeo Others ____________________ None of the above Alone With parents With colleagues With friends With partner Others (specify) ____________________________ Bi Bar Gay Bar Spa Videoke Bars Club Drinking joints Coffee shops Restaurants Movie house Malls Home Friends place Others _______________________________

None of the above

Thank you for completing this questionnaire.

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