PA Restaurant & Bar Workers Campaign

By completing and submitting this survey, you will be helping with the efforts of the Pennsylvania Restaurant and Bar Workers Campaign.

Your Name: *

Your Email: *

Your Phone Number:

Which restuarant or bar are you employed at?

Where is this restaurant or bar located?

Is this establishment smoke-free?
Yes
No

Rate your concern about your own personal exposure to secondhand smoke at work:

Estimate your co-workers' concern about their secondhand smoke exposure at work:

Estimate your management's level of concern about your secondhand smoke exposure at work:

In the next coming weeks, the Clean Air Council will be holding complimentary activities such as dinners and happy hours to provide you an opportunity to network with your peers and discuss your concerns about secondhand smoke. Would you consider attending an event?
Yes
No

www.86thesmoke.org