Orange County NC Website
• <br /> 009 ORANGE COUNTY EMPLOYEE SURVEY <br /> About Smoking at Work • <br /> Check the Answer that Applies to You: <br /> 1. What is your current status of tobacco use? <br /> a. Never smoked <br /> b. Ex-smoker/currently use no tobacco products <br /> c. Current cigarette smoker <br /> d. Current pipe or cigar smoker <br /> e. Currently use only smokeless tobacco (chewing tobacco or <br /> snuff) <br /> f. Currently smoke cigarettes and pipes or cigars <br /> g. Currently smoke and dip or chew <br /> 2 . How much do you smoke on average daily? <br /> a. Non-smoker--not applicable <br /> b. Dip or chew tobacco only <br /> c. Smoke less than 1/2 pack per day <br /> d. Smoke 1/2 to 1 pack per day <br /> e. Smoke 2 packs per day <br /> f. Smoke 2 or more packs per day <br /> g. Smoke 1-2 cigars or pipes per day <br /> h. Smoke 2-3 cigars or pipes per day <br /> i. Smoke 4 or more cigars or pipes per day <br /> 3 . How often do you smoke at work on average? <br /> a. Non-smoker--not applicable <br /> b. Do not smoke at work <br /> c. Seldom smoke at work <br /> d. Occasionally smoke at work (not daily) <br /> e. Smoke 1-2 times a day at work <br /> f. Smoke 3-4 times a day at work <br /> g. Smoke more than 4 times a day at work <br /> 4 . Where do you usually smoke at work? <br /> a. Non-smoker--not applicable <br /> b. At my work station (desk, work area, office) <br /> c. In an employee lounge <br /> d. In the restrooms <br /> e. In the hallways <br /> f. Outdoors <br /> g. Other <br /> (ovER) <br /> Page 1 of 6 <br />