Name *

First Name

Last Name

Name of your Business or Organization *

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Do you have a written statement affirming that substance use disorder is a health condition that is both common and treatable?

Yes

No

Does your workplace practice open and empathetic communication that supports people asking for help with a substance use disorder or maintaining their recovery?

Yes

No

Does your workplace offer any substance use or recovery specific support, like onsite recovery meetings, recovery coaching, or an identified person to seek out for support?

Yes

No

Does your workplace have someone on the executive team that is a visible ally for the recovery community?

Yes

No

Does your workplace provide significant financial or in-kind support to a local charitable organization or event that supports people effected by substance use disorder?

Yes

No

If alcohol is available at company functions, does it also have ample non-alcoholic options and are they well-advertised?

Yes

No

Does your workplace practice fair chance hiring which allows individuals with SUD-related incarceration or debt to compete for job opportunities?

Yes

No

Does your workplace offer a contingent or return-to-work agreement to support employees returning to work after a substance use related departure?

Yes

No

Does your workplace offer reasonable accommodations to support your employees’ and families’ health and wellness? Flexible work hours, for example.

Yes

No

Does your workplace provide health insurance that covers substance use disorder and mental health care at the same rate it covers physical health conditions?

Yes

No

Does your workplace offer any no-cost substance use disorder or mental health support, such as an Employee Assistance Program (EAP)?

Yes

No

Does your workplace regularly communicate with employees about recovery supports available to them (health insurance, EAP, etc), including at orientation?

Yes

No

Has at least one member of the HR department engaged in education around SUD as a health condition, SUD stigma, compassionate communication, and SUD and the Americans with Disabilities Act?

Yes

No

Does your workplace have staff-wide training on SUD, stigma, and recovery?

Yes

No

Does your workplace have Narcan readily available on site, and people trained to administer it?

Yes

No