Excellence in Work-Life Harmony Award Application
RequiredRequired Question(s)
Required 1.

Employer Name:

 

50 characters left.
Required 2.
Number of employees at organization:
1-10
10-50
50-100
100-500
500-1000
1000+
  • Comment:

  • 500 characters left.
Required 3.
Name of nominator if different from above contact info:
 

50 characters left.
Workplace Wellness Programs
 
Required 4.
Does your organization offer any of the following workplace wellness programs? (please check all that apply)
Smoking cessation
On-site gym or exercise class
Gym membership discounts
On-site physical examinations
College savings plans (529)
Ergonomic assessment and support
Weight control program
Nutritional education
Employee legal benefits
Hypertension testing
Stress management classes
Employee Assistance Program (EAP)
  • Comment:

  • 500 characters left.
Flexible Work Schedules
 
Required 5.
What flexible work options does your company offer? (please check all that apply)
Reduced hours
Compressed work weeks
Temporary or permanent switch to part-time
Telecommuting
Flexible start/stop times or core hours
Job sharing
  • Comment:

  • 500 characters left.
Maternity, Paternity and Family Leave Support
 
Required 6.
Does your employer offer additional paid time off (not including short-term disability) for maternity/paternity leave?
Yes
No
Required 7.
If so, how long is the paid time off offered?
 

50 characters left.
Required 8.
Does your employer offer unpaid maternity leave beyond the minimum required under Family Medical Leave Act (FMLA) and California Family Rights Act (CFRA)? 
Yes
No
9.
If so, how long is the unpaid time off offered?
 

50 characters left.
Required 10.
Does your employer offer additional time beyond Paid Time Off for family obligations?
Yes
No
11.
If yes, please describe.
 

50 characters left.
Required 12.
Does your employer offer additional paid time to take care of a close family member who is ill beyond the minimum required under Family Medical Leave Act (FMLA)?
Yes
No
13.
If yes, how many days?
 

50 characters left.
Required 14.
Does your employer offer additional unpaid time to take care of a close family member who is ill beyond the minimum required under Family Medical Leave Act (FMLA)?
Yes
No
15.
If yes, how many days?
 

50 characters left.
Required 16.
Does your employer offer any other benefits to support maternity, paternity or family illness? If so, please describe.
 

350 characters left.
Child Care Support
 
Required 17.
Does your employer provide any of the following financial supports for child care? (please check all that apply)
On-site or near-site company child care center
Child care subsidies for employees
Employer offers a Flexible Spending Account (FSA) for child care (employer does not contribute)
Contract with a child care provider to provide spaces for employees
Employer contributes to a Flexible Spending Account (FSA) for child care
Referral and information services for child care
  • Comment:

  • 500 characters left.
Employee Community Engagement Opportunities
 
Required 18.
Does your employer offer opportunities for employees to volunteer together or individually to help the local community?
Yes
No
19.
If yes, please describe.
 

350 characters left.
Work-Life Harmony and Workplace Culture
 
Required 20.
Does your organization have a work-life harmony policy or statement?
Yes
No
Required 21.
Does your company provide guidance and training to supervisors on work-life harmony, wellness, etc.?
Yes
No
Required 22.
Do your company's mission/values include language about work-life harmony or employee satisfaction? Or does the company website or marketing collateral prominently include such language? 
Yes
No
Required 23.
Are your employer's management and leadership staff strong role models for work-life harmony values? 
Yes
No
Required 24.
Does or has your employer supported public policy initiatives that address work-life harmony?
Yes
No
Required 25.
If chosen, is your organization willing to participate in the production of a short (two-minute) video about your organization, its policies and practices? Video to be produced in December 2018-January 2019.
Yes
No