Sample policy A (Includes parking lots and company-owned vehicles) Policy Statement:

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Sample policy A (Includes parking lots and company-owned vehicles) Policy Statement: Tobacco use is not permitted at any time, during and beyond working hours within any [employer] facility, whether owned or leased; in any [employer] vehicle; on any [employer] property and grounds, whether owned or leased; or in any vehicle on [employer] property and grounds. Policy Rationale: [Employer] is dedicated to providing a healthy and productive work environment for our employees, customers, and visitors. Tobacco use is a major cause of preventable disease and death. Scope: This policy applies to all employees. Violations will be handled in the same manner as violations of any other human resources policy. Page 1 of 8

Sample Policy B (Policy is enforced by building management) PURPOSE The purpose of this policy is to outline [employer] policy regarding employees use of tobacco products. POLICY [Employer] is committed to provide a healthy work environment for all employees. Employees, contractors, and visitors cannot use tobacco (cigarettes, cigars, chewing tobacco, snuff, pipes, etc.) during work time, including breaks and meal periods in any of the following locations: All buildings Parking lots, including private vehicles parked in the lots Any of the building grounds Immediate adjacent city sidewalks surrounding the buildings Each specific location has defined the specific tobacco-free areas. Employees and contractors are responsible for knowing and understanding the tobacco-free area of their location and should contact their supervisor if they have questions. Littering of tobacco-related products on the grounds or parking lots is also prohibited. PROCEDURE(S) SMOKING CESSATION Employees who have [healthplan] insurance may call [enter phone number] for information regarding the availability of tobacco cessation programs. Employees who do not have insurance, may contact [alternative vendor]. All employees may review the stop-smoking resources information on our intranet site under [For Employees/Quit Smoking Help]. SUPERVISOR/MANAGER RESPONSIBILITY Supervisors/managers are responsible for: Reviewing this policy with employees under their supervision and providing employees with location-specific information regarding the defined tobacco-free areas. Enforcing this policy for all employees covered by this policy, whether or not such employees report to the supervisor/manager. Informing visitors if they are smoking in a prohibited area and that they may not use tobacco in this area. Investigating all allegations of violations of this policy in a timely manner and taking disciplinary action, as appropriate. Page 2 of 8

ENFORCEMENT PROCEDURE An employee who violates this policy may be subject to disciplinary action, up to and including discharge. Building management personnel will be requested to monitor or report any potential violations of the policy. [Employer] will work with [building management company] to determine if increased capacity exists or could be added, at a reasonable cost, during an initial enforcement period in [date]. Any management representative, e.g., supervisor, Director, Vice President, etc. will be expected to enforce the Policy (as described above) if he/she observes any potential violations of the policy. When building management personnel observe an employee smoking in violation of the policy, building management personnel will approach the employee and issue the employee a Tobacco Use Violation. Building management personnel will not engage in discussions / explanations / arguments with the alleged violator, but will simply issue the violation notice to the employee. If the alleged violator refuses to provide his/her name to the building management personnel, the building management personnel will report this to [employer] human resources. Building management personnel will provide two copies of any Violation notices issued to [employer] human resources at the end of each day. Human Resources will maintain one copy of the violation notice and will determine the direct supervisor of the employee and send a copy of the violation notice to the supervisor. The supervisor will conduct an investigation regarding the alleged violation of the tobacco use policy. Based upon the outcome of the investigation, appropriate action will be taken. DISCIPLINARY PROCEDURE For employees governed by a Collective Bargaining Agreement, violations of the tobacco use policy will be treated as any other policy violation. Although each situation has to be handled on a case by case basis, a typical discipline would be coaching for the first violation; and an oral warning for a subsequent violation; a written warning for a subsequent timely violation; a suspension for a subsequent timely violation; a longer suspension for a subsequent timely violation; discharge. For employees not governed by a Collective Bargaining Agreement, violations of the tobacco use policy will be treated as progressive discipline similar as described above for union employees. Page 3 of 8

Sample Policy C (Health care facility) PURPOSE: [Organization] Hospital s/clinic s mission is to improve the health of our patients and community by providing high-quality health care that meets the needs of all people. The health hazards of tobacco use are well known within the medical community. Tobacco use is the number one cause of preventable illness and death in Minnesota and across the nation. Allowing the use of tobacco products in and around our campus does not portray the image of our hospital as a health care leader in the community and does not promote a healthy environment for our patients or employees. Assisting our employees, our patients and our visitors to be tobacco-free is consistent with our mission to improve the health of the community we serve. SCOPE: This policy applies to all patients, visitors and employees of [Organization] Hospital/Clinic. POLICY: 1. The sale or use of tobacco products (cigarettes, cigars, chewing tobacco, snuff, pipes, etc.) is prohibited in or on all Hospital/Clinic owned or leased buildings, grounds, parking lots, ramps, plazas or vehicles. No exceptions to this policy will be granted. 2. Employees will not be allowed to use tobacco products during their paid work time (breaks) and are strongly encouraged not to use tobacco products during their unpaid work time (lunch). Smoke odors at any time are not allowed (Cross reference: Human Resources Policy). 3. Employees are prohibited from using tobacco products on the campus and adjacent property (perimeter sidewalks) anytime during their work shift. 4. Signs will be posted at strategic locations around the facility to notify staff, visitors and patients of this policy. 5. Patients will be informed of this policy upon arrival or as soon thereafter as is medically appropriate. 6. Patients will be informed of the smoking policy on admission through the distribution of the patient handbook. 7. No physician with privileges at [Organization] Hospital/Clinic may write orders for a patient to use tobacco products on the Hospital/Clinic campus. 8. All employees are authorized to communicate this policy with courtesy and diplomacy to other employees, patients and visitors. Page 4 of 8

9. Department supervisors and managers are expected to educate employees about this policy and ensure that the policy is implemented and enforced. Monitoring of this policy will be shared with Hospital/Clinic security. At facilities where security officers are not present, facility managers and supervisors are expected to monitor and enforce this policy. 10. Use of tobacco products is prohibited in all company vehicles. 11. Compliance with this policy is expected and employees who violate this policy will be subject to current disciplinary procedures. 12. Certain religious groups may request to burn tobacco as part of their religious / spiritual practices. This will be allowed in the hospital chapel with prior approval from Pastoral Services. Pastoral Services staff must be present during the burning ceremony. PROCEDURES: This policy will be communicated to all employees, physicians, patients, and family members, utilizing patient information resources, employee newsletters, Human Resource processes, and appropriate signs at entrances and patient/visitor areas. Smoking shelters and ash receptacles will be removed. Appropriate medications will be prescribed for both in-patients and out-patients experiencing nicotine withdrawal; educational resources and support programs will be provided to employees to empower smoking cessation. Staff who wear scrubs will be required to change to street clothes prior to leaving the campus to smoke. Security staff will enforce this policy by: - Informing patients/visitors (who are in violation) of the policy and suggesting offcampus areas if they choose to smoke. - Citing employees in violation and initiating corrective action. CORRECTIVE ACTION: When an employee is cited for violating policy, the employee s supervisor will be informed by the security department. The first violation will result in a verbal warning, the second violation in a written warning, the third in a period of probation, the fourth in a period of suspension, and the fifth in termination of employment. Every effort will be made to assist employees with resource information and their understanding of this policy. Employees will be provided information on smoking cessation resources, and supervisors will support employees who seek help in stopping smoking. Supervisors are responsible to educate employees about this policy and to ensure that this policy is implemented and enforced. Page 5 of 8

Sample policy D (Includes field workers and construction equipment) I. PURPOSE This policy sets forth our commitment to providing a safe and healthy workplace and to promoting the health and well-being of our employees. II. SCOPE This policy shall cover all employees of [Organization] and its subsidiaries unless subsidiary companies have in place an approved policy of their own. III. PROCEDURE A. Tobacco use is prohibited in company buildings and on company owned grounds. B. Tobacco use will not be allowed in any company owned or leased vehicles or equipment. C. Any concerns about the application of this policy should be brought to the attention of the manager or human resources. D. Employees who violate this policy will be subject to disciplinary action up to and including termination. Page 6 of 8

Sample policy E (Explicitly covers smokeless tobacco; allows smoking in private cars) POLICY: It is [employer] policy to provide a tobacco-free environment for all employees and visitors. This policy covers the smoking of any tobacco product and/or the use of smokeless or spit tobacco. This includes but is not limited to: cigarettes, pipes, cigars, snuff and chewing tobacco. POLICY RATIONALE: This policy has been adopted for the following reasons: 1. Our organization is dedicated to providing a healthy and productive work environment for employees and visitors. 2. Tobacco use has been determined to be a major cause of preventable disease and death. 3. The effects of secondhand smoke greatly impact non-smokers. 4. Medical costs are escalating. SCOPE: Tobacco products may not be used within company facilities or on company property. Tobacco products may not be used in any company vehicles. Tobacco products may be used within personal vehicles parked on company property, before or after work or during regularly scheduled work breaks. PROCEDURES: Visitors, including vendors, should be informed of this policy by their host or primary business contact. Violations of this policy will be handled through the standard disciplinary procedure. Page 7 of 8

SAMPLE CREATE IN TRIPLICATE FRONT BACK Smoking/Tobacco Use Violation Date: Time: Location: Employee Name: Department: Building Management Representative Date or Supervisor issuing the violation copy 1: employee copy 2: human resources copy 3: supervisor [Organization Name] prohibits the use of all tobacco products (cigarettes, cigars, chewing tobacco, snuff, pipes, etc.) in or on [list areas where smoking is prohibited]. This policy applies to ALL visitors and employees. A copy of this violation will be kept in Human Resources and a copy will be sent to the employee s supervisor. Employees smoking or using tobacco products in violation of the Policy are subject to discipline, up to and including termination. Smoking Cessation Resources The policy does not require employees to quit smoking. For employees who do want to quit, [employer] provides the following resources: Stop-smoking program name [phone # / website] Quit medications (list those available and contact for more information)