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Smoke-free Haringey Awards
Please fill in your details on the form below to apply for a Smoke-free Haringey Award.
Name of Applicant
*
Business Name
*
Address
*
Postcode
*
Telephone
*
Email
*
If you would like to post your application, please download, print and complete the form and send to:
Caroline Hulett
Smoke-free Haringey
Block 6, 1st Floor
St Ann's Hospital
St Ann's Road
Tottenham
N15 3TH
Type of premises:
Workplace
,
please specify:
(e.g. office, factory etc)
Eating Establishment
Pub or Club
Other
,
please specify:
(e.g. hair dresser, shop, hotel)
Number of emplyees:
Less than 10
10-50
50 - 250
More than 250
Is smoking permitted anywhere inside your premises?
Yes
,
please specify:
No
Does your business/organisation provide exterior smoking areas?
Yes
,
please specify:
No
Do you have a separate written policy regarding smoking?
Yes
No
Does your business/organisation offer appropriate stop smoking information and support to employees that may wish to quit?
Yes
No
If the answer is no, would you like further information about information and support that is available locally?
Yes
No
Where did you hear about Smoke-free Haringey?
On the internet
Advertising in local papers
Mail-out
Other
,
please specify:
