MARINE CORPS COMMUNITY SERVICES HENDERSON HALL HEADQUARTERS AND SERVICE BATTALION, HEADQUARTERS MARINE CORPS, HENDERSON HALL P.O. BOX 4009, ARLINGTON, VA 22204-0009 MARINE CORPS COMMUNITY SERVICES STANDARD OPERATING PROCEDURE 1710.1 From: Director To: Division and Branch Heads Subj: CIVILIAN EMPLOYEE WELLNESS PROGRAM (CEWP) Encl: (1) Letter to Participant (2) Target Fitness Informed Consent (3) List of approved activities (4) Health History Questionnaire (5) Physician s Referral Form (6) Physician s Approval Form (7) Health and Fitness Philosophy and Goal Sheet (8) Memorandum of Understanding for Participant (9) Memorandum of Understanding for Participant and Supervisor (10) Employee Fitness Program Record Sheet MCCSSOP 1710.1 SF 6 Oct 2010 1. Purpose. To establish a Civilian Employee Wellness Program based on guidance from the Department of the Navy. This program is designed to promote improvement of personal physical health of participating individuals and to benefit the Battalion through improved readiness and productivity from a healthy workforce. The goal of participation in this program is to encourage employees to pursue health and wellness activities on their own time and adopt personal goals and activities that contribute to a healthy lifestyle. 2. Information. a. Civilian employees may be excused from duty without charge to leave to participate in the CEWP. Supervisors may approve excused absences of no more than three 59 minute periods per employee, per week to participate in this program. Time cannot be accumulated and carried over from week to week. Participation in this fitness program is a privilege and can be withdrawn at any time the supervisor deems appropriate. b. Excused absences for this purpose cannot interfere with or impede the progress of the command/activity s mission. c. The program will be conducted using one or more of the following approved activities: running, walking, swimming, weight training, aerobics, biking, stress reduction/relaxation exercises (yoga, meditation, Tai-chi), or any other activity as approved by the supervisor as prudent and can be accomplished within specific timeframes. Any weight training activity shall be restricted to toning. Power lifting or strenuous lifting will not be authorized.
d. Employee participation in an exercise program in addition to this officially sponsored program may also be accomplished through flexible work scheduling and leave usage with prior approval from the supervisor. MCCSSOP 1710.1 1 Oct 2010 e. Since employees participating in this program are in a duty status, injuries sustained during physical fitness activities may be covered by the Office of Workers Compensation Program. For the protection of both the employee and the Marine Corps, injuries must be reported promptly to the first-level supervisor even if no medical attention is sought. This protects the employee entitlements if complications later develop. f. This program may be terminated at the discretion of the Commanding Officer due to mission requirements. Managers and/or supervisors may also terminate the program for participating employees due to mission requirements, program compromise, or abuse. 3. Action. a. Employees (1) Employee participation in this CEWP is completely voluntary. Interested employees will be provided an overview of the program, in the form of the Letter to Participants, enclosure (1). Each participant must take full responsibility to ensure a medical physician has authorized participation in a fitness program. The employee will provide Target Fitness Informed Consent Form, enclosure (2), employee must read list of approved activities sheet enclosure (3) A Health History Questionnaire, enclosure (4) A Physician s Referral Form, enclosure (5) and a Physicians Approval Form, enclosure (6). The required medical forms from their primary care provider/physician will be at the employees own expense stating that physical fitness activities are permitted with or without limiting conditions. Each participating employee shall provide a new copy of these forms annually and prior to returning to the CEWP from any injury, limiting medical condition, pregnancy, etc. (2) The fitness program activities must take place at the employees assigned duty station. The excused time includes any travel to and from the location of the exercise, and personal grooming needs. (3) Prior to the start of the program, the participating employee will complete a Health and Fitness Philosophy and Goal Sheet, enclosure (7). The Health Promotions Coordinator will assist with the preparation of this document. b. Supervisors (1) Supervisors must provide a copy of the Memorandum of Understanding for Participant, enclosure (8) and the Memorandum of Understanding for Participant and Supervisor, enclosure (9) to the civilian Human Resources Office for each employee, prior to commencing the program. (2) Supervisors of employees participating in a fitness program will determine and control employees participation and must account for the employees time in the fitness program. This accounting of time must be recorded by each program participant contained in the Employee Fitness
Program Record Sheet, enclosure (10). Supervisors may revoke participation if any abuses are not corrected immediately. In accordance with the appropriate guides, references and applicable laws, employees may be disciplined for abusing this program. MCCSSOP 1710.1 1 Oct 2010 (3) Supervisors may grant excused time in increments of 59 minutes or less per absence and may not exceed three (3) hours per week. Supervisors may allow an employee to participate at the beginning or end of the workday, or in conjunction with the normal lunch period. Employees who elect to exercise at the beginning of the work day must report to work first and those who elect to exercise at the end of the workday must report back to work prior to departing for home. The program may not be used to arrive late for work or depart early. Participation is not allowed on days when overtime, compensatory time or credit hours are earned. The MCCS point of contact for this program is: Mr. Akida H. Jordan Semper Fit Division Health Promotions Coordinator 703-693-8573/703-614-5959 Akida.jordan@usmc.mil ROGER G. WEGER
Dear Participant, LETTER TO PARTICIPANT Civilian Employee Wellness Program Participant Marine Corps Community Service Base Henderson Hall Thank you for your interest in the Marine Corps Community Services Base Henderson Hall Civilian Employee Wellness Program. Studies show that improved health overall improves morale, productivity at work and home, and less illness. Upon approval from your supervisor, you will be permitted to attend classes or exercise on base, no more than three 59 minute sessions per week, during the next six months. The time allowed will be three hours of government time. The use of these hours for anything other than attending classes or utilizing the base gym or pools for exercise will not be permitted. During the next six months, you will improve your health and quality of life by participating in a program that accommodates your needs. These next six months will be a learning process in order to help you understand the benefits of a healthier lifestyle. With the onset of the importance of preventative health care this past decade, the Wellness Committee is committed to helping you achieve your goals so you can reap the benefits of a healthy lifestyle. Health education/training courses will be presented throughout the year and will offer the latest information on nutrition, stress management, health management, cardiovascular disease risks, weight management, smoking education and cessation, and physical activity. Therefore, no matter what your current fitness level and health status may be, this program is designed to start you on your way to a healthier you. You will be required to attend classes that pertain to your own individual needs and interests. These classes go hand-in-hand with physical activity and are required because they will help you achieve your goals. Therefore, for most people, starting a very basic program is safe. However, sometimes a medical clearance is necessary. Thus, if you are a man over age 40, a woman over age 50, have not exercised on a regular basis (within six months), or answer yes to any of the questions on the Physician s Referral Form, you will have to provide your doctor s approval before making an initial appointment at the Semper Fit Division, Building 25 Keith Hall. Otherwise, complete this packet and make an initial appointment at 703-614- 5959 or 703-693-8573. To your health, Akida H. Jordan Semper Fit Division Health Promotions Coordinator Enclosure (1)
TARGET FITNESS INFORMED CONSENT The undersigned hereby gives informed consent to engage in a series of health and medical screenings, which include a micro fit health and fitness exercise assessment and a medical evaluation. The purpose of these tests is to determine my initial physical fitness and health status. Exercise testing will be conducted with the Micro Fit Health and Fitness Evaluation System, which is located at the Smith Gym, Building 27. The program procedures will include the following: Medical Evaluation, Screening, and Blood Pressure. Complete review and discussion of your packet and your overall health and fitness goals will be discussed with your evaluator. This discussion will determine whether or not you will be at risk during participation in the MCCS Henderson Hall Civilian Employee Wellness Program and whether or not you need a medical evaluation by your physician prior to entering the program. A blood pressure cuff will be used to determine blood pressure. Health and Fitness Evaluation. This computer system will determine the overall initial physical condition of the individual. Six tests will be given to the individual, which include the following: Blood Pressure. A computerized pressure cuff will be used to determine blood pressure. Resting Heart Rate. A resting heart rate will be determined during the measuring of blood pressure with the computerized pressure cuff. Body Fat Analysis. Skin fold calipers will be used to determine body composition. Cardiovascular Assessment. A stationary bike and a Polar heart rate monitor will be used to determine aerobic fitness. Flexibility. A sit and reach apparatus will be used to determine back flexibility. Strength. An isometric bicep curl bar measured in foot-pounds will determine upper body and bicep strength. At the end of the fitness assessment, the individual will receive a complete fitness profile report. The report will determine the individual s strengths and weaknesses in the above-mentioned categories. A trained health professional will discuss the report results as well as discuss the entire program. The fitness assessment and exercise program will be two separate appointments and will not take more than an hour for each appointment. I understand that these two appointments are to be included in my total (72 hours) hours of the program. The benefits of such testing and consultation are to prevent any future health hazards that may affect my overall wellness. A prescription of exercises and classes may be facilitated in order to better my lifestyle habits. All records and results from this testing will be held in strict confidence unless my written consent is obtained. Enclosure (2)
I understand that a trained specialist will supervise, directly or indirectly, the MCCS Henderson Hall Civilian Employee Wellness Program in which I will participate. There may be some slight risk associated with the exercise program. There is a chance that some cardiovascular problem could develop and, in a very rare instance, a heart attack could occur. Excessive exercise in hot, humid conditions can lead to heat injury such as heat exhaustion or heat stroke. This danger can be reduced by altering my exercise program during hot, humid weather; by drinking plenty of water; and by recognizing the early signs of heat injury. Careful medical screening prior to entering the program minimizes these risks. If further diagnostic of therapeutic care is needed, I understand that it is my financial responsibility. There are numerous benefits to participating in the MCCS Henderson Hall Civilian Employee Wellness Program. I will learn how to improve my diet, lose weight, manage stress, and how to exercise safely and effectively through attending classes and exercising during specified hours during the weeks on my program. Improving these health practices is thought to improve my overall health status and functional ability. I have had the chance to have my questions answered to my satisfaction about this program. I understand that if I have additional questions, I may contact Akida Jordan, Heath Promotions Director, Semper Fit Division, at 703-693-8573. Signature Date Witness Signature Date Enclosure (2)
HEALTH HISTORY QUESTIONNAIRE NAME: DATE: WORK PHONE: SEX: M F AGE: PERSON TO CONTACT IN CASE OF EMERGENCY: NAME: RELATIONSHIP: PHONE: ALTERNATE PHONE: ARE YOU TAKING ANY MEDICATIONS OR DRUGS? IF SO, PLEASE LIST MEDICATION, DOSE, AND REASON. DOES YOUR PHYSICIAN KNOW YOU ARE PARTICIPATING IN THIS PHYSICAL FITNESS PROGRAM? DESCRIBE ANY PHYSICAL ACTIVITY YOU DO SOMEWHAT REGULARLY: DO YOU HAVE OR HAVE YOU HAD IN THE PAST: YES NO 1. History of heart problem, chest pain stroke 2. Increased blood pressure 3. Any chronic illness or condition 4. Difficulty with physical exercise 5. Advice from physician not to exercise 6. Recent surgery (last 12 months) 7. Pregnancy (now or within the last 3 months) 8. History of breathing or lung problems 9. Muscle, joint and back disorder or previous injury still effecting you 10. Diabetes or thyroid condition 11. Cigarette smoking habit 12. Obesity (more than 20% over ideal weight) 13. Increased blood cholesterol 14. History of heart problems in immediate family 15. Hernia or any condition that may be aggravated by lifting weights Please explain any yes answers. COMMENTS: DO YOU HAVE ANY OTHER CONCERNS YOU DESIRE TO EXPRESS PRIOR TO ENGAGING IN THIS PHYSICAL FITNESS PROGRAM? YES NO IF YES, PLEASE EXPLAIN: SIGNATURE: REVIEWED BY: DATE: DATE: Enclosure (4)
PHYSICIAN S REFERRAL FORM Dear Dr., Date: Your patient,, desires to participate in a physical fitness program at the gym located at his/her workplace with a health and fitness professional. Our initial medical screening identified the following potential risk factors: Age - 40 years or more (males); 50 years or more (females) Smoking Diabetes BMI measurement of indicates minimal, low, moderate, high, very high, extremely high disease risk factor Family history of cardiovascular disease in parent or siblings prior to age 55 Symptoms or signs suggestive to cardiopulmonary disease Has not been recently (within six months) involved in a regular moderate exercise program Other Because of these factors, our guidelines require your patient to obtain a clearance from you prior to participation in a physical fitness program. This program is voluntary on the part of your patient because he/she is concerned about his/her health and would like to participate in a program that would better his/her overall health. Please complete the attached Physician s Approval Form and return it to the Semper Fit Division either by your patient or by mail, or by fax to (703) 695-4765. If you have any questions, please contact the Semper Fit Division at (703) 695-1591 or (703) 693-8573. Enclosure (5)
PHYSICIAN S APPROVAL FORM Return to the Semper Fit Division either by the patient or by mail to: Health Promotions Coordinator Attn: Akida Jordan Marine Corps Community Services Semper Fit H&S Bn, HQMC Henderson Hall PO Box 4009 Arlington, VA 22204-0009 Or fax to: (703)-695-4765 has medical approval to (Print patient s name) participate in a physical fitness program at the MCCS Henderson Hall in Smith Gym. I understand that the program includes mild to moderate intensity exercise, is conducted individually or in a group, and is either supervised or unsupervised. I also understand that participation is voluntary, allowing the participant to stop and rest at any time he/she desires. The following restrictions apply (if none, so state): Physician s Name: Physician s Signature: Telephone: Date: Enclosure (6)
HEALTH AND FITNESS PHILOSOPHY AND GOAL SHEET Please write a statement on how you believe you will benefit from enrolling in the MCCS Henderson Hall Civilian Wellness Program. Please list the immediate, intermediate, and long-term goals in relation to your health and fitness. Immediate: Intermediate: Long-Term: EMPLOYEE SIGNATURE: DATE: Enclosure (7)
MEMORANDUM OF UNDERSTANDING FOR PARTICIPANT I,, understand that my full participation in the MCCS Henderson Hall Civilian Wellness Program will require three onehour sessions each week for a total of 72 hours over the course of six months, unless illness or injury dictate otherwise. I understand that participation will be my place of duty if permitted to attend during working hours. I hereby agree to hold harmless and release the United States Marine Corps and the United States Navy of all claims and demands resulting from any loss, damage, death, or injury to me or my property that may arise due to my participation in this program other than negligence on my behalf. I understand that some portions of this program may be physically demanding and I certify that I am in sufficient health to participate in the MCCS Henderson Hall Civilian Employee Wellness Program. I have read and understand the requirements of the participant guidelines. Employee s Signature: Date: Enclosure (8)
MEMORANDUM OF UNDERSTANDING FOR PARTICIPANT AND SUPERVISOR Name of Employee: Directorate/Program Number: Name of Supervisor: Bldg #: Job Title: Work Phone Number: Fax Number: E-mail Address: I,, the supervisor of the individual stated above, understand that he/she will be participating in the MCCS Henderson Hall Civilian Employee Wellness Program for three one-hour sessions each week for a total of 72 hours over the course of six months. I understand that participation will be the place of duty for the above-mentioned individual and that I agree to allow my employee to attend during working hours beginning and ending. I also understand that the exercise periods are official duty time. Failure to use exercise time appropriately or misconduct during these periods will be considered workplace infractions and will be subject to disciplinary action. I also am aware that unused exercise hours of the participant may not be carried forward to subsequent weeks nor can they be used for any non-duty purpose. Employee/Participant: Date: Participant Approve/Disapprove: Date: Supervisor Approve/Disapprove: Date: Director Enclosure (9)
Civilian Employee Wellness Program Record Sheet Employee Division DATE TIME START TIME END LOCATION & ACTIVITY Employee Signature: Supervisor Signature: Date: Date: Enclosure (10)
List of Approved Activities For purposes of coverage under the Civilian Employee Wellness Program (CEWP) only recognizes the physical fitness activities listed below as approved aerobic activities: Approved activities are those that address one or more of the following three areas of fitness: (1) aerobic/cardiovascular endurance (2) strength training (3) flexibility The following activities are authorized as aerobic activities for CEWP: a) Brisk walking b) Jogging c) Running d) Cycling e) Stair climbing f) Rowing g) Swimming h) Rope-skipping (Jumping Rope) i) Skating j) Aerobic exercises (such as aerobic classes, calisthenics, etc.) k) Strength/resistance exercises (such as weight training, including the use of free weights, calisthenics, etc.) l) Flexibility exercises (such as stretching, yoga, etc.) An employee who is ranked fair or better after completion of their aerobic assessment may also be certified to perform the following four physical fitness activities: Activities not listed above are not part of this program, and are not covered by the CEWP Enclosure (3)