SmokeFreeWorking - Getting started

Getting started Questionnaire

A good starting point is for you to give us some basic information about your organisation and we can get back to you with suggestions.

Please complete all or as much of this form as you have time for, then click 'Send' at the bottom.

This form is for companies enquiring about our services only, if you are looking to signup for a desktopquitting user account, please click here.

Questions: 1 to 11
Q1 Company name:
Q2 Address:
Q3 Website:
Q4 Contact name:
Q5 Your position:
Q6 Phone:
Q7 Email:
Q8 No of employees:
Q9 What sort of business does your organisation provide?:
Q10 Where are your employees sited? I.e. number of branches, buildings, external workers:
Q11Age and gender breakdown of workforce if possible or guestimate in percentages:: Male / Female:; Ages:; 16-24/25-34/35-44/45-54/55-64/65+

Questions: 12 to 17
Q12 What percentage do you think smoke?:
Q13.aDo you have any of the following (please give a basic description):: An occupational health service:; Q13.b A smoking policy:; Q13.b Health and fitness facilities for staff:
Q14 Where do smokers go to smoke now?:
Q15 How would you like to see stop smoking support developed at your organisation?
Q16 Current place of work?
Q17 When and how would you like us to contact you?:
Thank you for completing this questionnaire.