Get the free Employee Tobacco Attestation Form - Campbell University - campbell

Employee Tobacco Attestation Form Effective for Plan Year January 1, 2016, December 31, 2016, Campbell wishes to promote healthy lifestyle choices for its employees, and does so in part by using healthcare

How to fill out employee tobacco attestation form

How to fill out an employee tobacco attestation form:

1. Begin by reading the instructions provided on the form carefully. These instructions will guide you on how to accurately fill out the form.
2. Provide your personal information, such as your full name, employee identification number, and contact details. This information helps to identify you as the employee filling out the form.
3. Indicate whether you are a smoker or a non-smoker. This attestation form aims to gather information regarding tobacco usage among employees, so it is important to be honest in your response.
4. If you are a smoker, you may be required to provide additional details about your smoking habits. This might include the frequency of smoking, the number of cigarettes smoked per day, or any past attempts to quit smoking.
5. Sign and date the form once you have completed all the necessary sections. Your signature serves as a confirmation that the information provided is accurate and true to the best of your knowledge.
6. Submit the filled-out form to the designated person or department, as instructed on the form. This could be your human resources department or any other relevant authority responsible for maintaining records and addressing any concerns related to employee tobacco usage.

Who needs an employee tobacco attestation form?

1. Employers may require their employees to fill out a tobacco attestation form as part of their workplace wellness programs or to comply with health regulations.
2. Insurance companies may request this form to assess health risks and determine insurance premiums for their policyholders.
3. Government agencies, such as those involved in public health initiatives, may require employees in specific sectors to complete this form for data collection and research purposes.
4. Any organization that aims to promote a smoke-free workplace environment may utilize this form to monitor smoking habits among its employees and implement appropriate policies or assistance programs.

Remember, the specific requirements for the employee tobacco attestation form may vary depending on your organization or jurisdiction. Always follow the instructions provided and consult with the relevant authorities if you have any doubts or questions about filling out the form.

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What is employee tobacco attestation form?

Employee tobacco attestation form is a document where employees certify whether or not they use tobacco products.

Who is required to file employee tobacco attestation form?

All employees are required to file the employee tobacco attestation form.

How to fill out employee tobacco attestation form?

Employees can fill out the form by indicating whether they use tobacco products or not and providing any required information or signatures.

What is the purpose of employee tobacco attestation form?

The purpose of the form is to gather information about employees' tobacco use for health and insurance purposes.

What information must be reported on employee tobacco attestation form?

Employees must report their tobacco use status and may be required to provide additional information such as frequency of use.