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

Employee Tobacco Attestation Form Effective for Plan Year January 1, 2019, December 31, 2019, 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 employee tobacco attestation form

1. To fill out the employee tobacco attestation form, follow these steps:
2. Start by entering the employee's personal information, such as their name, address, and contact details.
3. Next, indicate the employee's job title and department within the organization.
4. Provide information about the employee's tobacco usage, including whether they smoke, chew tobacco, or use any tobacco products.
5. Specify the frequency and duration of tobacco usage, if applicable.
6. If the form requires it, indicate whether the employee is willing to participate in any smoking cessation programs or interventions.
7. Sign and date the form to verify its authenticity.
8. Submit the completed form to the relevant department or HR personnel.

Who needs employee tobacco attestation form?

1. The employee tobacco attestation form is needed by any organization or employer that wants to gather information about their employees' tobacco usage. It helps in creating a record of employees who use tobacco and may be used for various purposes, such as health insurance policies, wellness programs, or enforcing workplace smoking regulations.

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What is employee tobacco attestation form?

The employee tobacco attestation form is a document that employees fill out to declare their tobacco use status for health and insurance purposes.

Who is required to file employee tobacco attestation form?

Typically, all employees enrolled in an employer-sponsored health plan may be required to file the employee tobacco attestation form.

How to fill out employee tobacco attestation form?

To fill out the employee tobacco attestation form, an employee must provide their personal information, indicate their tobacco use status, and sign the document confirming the accuracy of the information.

What is the purpose of employee tobacco attestation form?

The purpose of the employee tobacco attestation form is to help employers evaluate health risk and potentially adjust insurance premiums based on employees' tobacco usage.

What information must be reported on employee tobacco attestation form?

Employees must report their tobacco usage status, including whether they currently use or have used tobacco products within the specified time frame.