Smokefree Workplace Policy

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It may be reproduced in
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the source and no commercial usage or sale.
Copyright NSW Health Department 1999

State Health Publication No: (HP) 000001
ISBN: 07 3473 1280
Circular No: 99/76
December 1999
TABLE OF CONTENTS
1. BACKGROUND........................................................................................................................ 1
2. RATIONALE ............................................................................................................................ 2
3. POLICY STATEMENT .............................................................................................................. 3
4. PHASES OF THE POLICY........................................................................................................ 3
4.1 OVERVIEW ....................................................................................................................... 3
Table: ............................................................................................... Phases of the Policy
4
4.2 PHASE ONE : DEVELOPMENT OF AN IMPLEMENTATION STRATEGY BY AREA HEALTH SERVICES......... 5
Component 1 Publicity and promotion .............................................................................. 5
Component 2 Establishing the working party..................................................................... 6
Component 3 Application for exemptions .......................................................................... 7
4.3 PHASE TWO: INTRODUCTION OF A SMOKE FREE CAMPUS WITH EXEMPTIONS .................................. 8
4.4 PHASE THREE: REVIEW OF THE POLICY .................................................................................. 8
4.5 PHASE FOUR: TOTALLY SMOKE FREE PUBLIC HEALTH FACILITIES AND CAMPUSES .......................... 8
5. EXEMPTIONS AND FLEXIBLE APPLICATION OF THE POLICY................................................. 9
5.1 GUIDELINES FOR EXEMPTIONS ............................................................................................. 9
5.2 STAFF........................................................................................................................... 10
5.3 PATIENTS ...................................................................................................................... 10
5.4 COMMUNITY HEALTH EMPLOYEES ...................................................................................... 11
5.5 FLEXIBLE APPLICATION OF THE POLICY ............................................................................... 11
6. IMPORTANT IMPLEMENTATION COMPONENTS.................................................................... 12
6.1 CESSATION SUPPORT ...................................................................................................... 12
6.2 ENFORCEMENT PROCEDURES & DISCIPLINARY ACTION ........................................................... 12
6.2.1 Staff................................................................................................................... 12
6.2.2 Patients, Clients and Visitors................................................................................ 13
6.3 GRIEVANCE PROCEDURES ................................................................................................. 13
6.4 SIGNAGE ....................................................................................................................... 13
6.5 DISPOSAL BINS ............................................................................................................... 14
6.6 CONTRACT SERVICES ...................................................................................................... 14
6.7 SHARED OFFICE ACCOMMODATION ..................................................................................... 14
6.8 CONTRACT OF EMPLOYMENT ............................................................................................. 14
6.9 LEASING AGREEMENTS .................................................................................................... 14
6.10 BUILDING AND CONSTRUCTION AGREEMENTS........................................................................ 15
7. POLICY REVIEW ................................................................................................................... 15
7.1 POLICY EVALUATION FRAMEWORK ...................................................................................... 15
8. KEY DEFINITIONS ................................................................................................................. 17
1. Background
The NSW Department of Health, is committed to ensuring the health, safety and welfare of
all persons utilising its facilities and services. Medical evidence has confirmed that
tobacco smoking is detrimental to health by causing disease and ill health. The health
effects include lung cancer, bronchitis, emphysema, laryngeal cancer, soft tissue lesions
of the lip and mouth and cardio-vascular disease. In the last two decades medical
evidence has also highlighted the risks associated with the inhalation of environmental
tobacco smoke (ETS) or passive smoking.
ETS is a carcinogenic compound that contains more than 4,000 chemicals including 43
known carcinogens. It is a combination of side-stream smoke and exhaled mainstream
smoke or second hand smoke. Research has identified short term and long term effects
of passive smoking. Short term effects include eye irritation, coughing, headaches,
reduced lung function in asthmatic non smokers, reduced attentiveness and problem
solving ability and increased agitation.
Long term effects include lung cancer, pneumonia, increased risk of lung damage in non
smokers, increased serious respiratory illnesses such as bronchitis and pneumonia in
children whose parents are smokers, slower lung growth and poorer lung function in young
children whose parents smoke and coronary heart disease.
The Department has had a policy to reduce exposure to passive smoking on Department
property since 1984. In 1988 this policy was amended to reflect concerns about the health
effects of passive smoking and to incorporate the requirements of the NSW Occupational
Health and Safety Act 1983. The revised policy was issued as Circulars - 88/118 Policy
on Smoking in the Workplace and 88/244 Department of Health NSW Policy on Smoke
Free Working Environment. The Department adopted this policy to ensure that an
atmosphere free of tobacco smoke would be regarded as the workplace norm. As stated
in the policy,
“The general aim of the policy was to ensure that a safe environment be provided
so that all staff, clients, patients and visitors are protected from the health hazards
and discomfits associated with exposure to tobacco smoke in all public health
facilities in NSW.”
The 1988 policy focused on the obligations of the Department to provide a smoke free
working environment following common law cases concerning the effects of passive
smoking. The policy noted the responsibility of employers to provide a workplace free from
hazards to air quality under the NSW Occupational Health and Safety (OHS) Act 1983.
The 1988 policy also acknowledged the Department’s role in the promotion of healthy
lifestyles and practices. The Area Health Services Act 1986 states a primary objective of
an Area Health Service is (s.19) “to promote, protect and maintain public health....”, as
such it is recognised that the Department and Health Services have a role in the promotion
of health. The promotion of smoke free policies and other related health promotion
strategies in health care facilities is an essential component in protecting the health of
NSW Department of Health

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those who come into contact with these institutions.
The 1988 Smoking Policy imposed a ban on smoking by all staff, patients and visitors
within Health Department buildings and vehicles owned by the Department. This included
buildings and vehicles of public hospitals, Area Health Services and associated
organisations.
In early 1997, the Department conducted a survey on the status of the 1988 Smoking Policy
and concerns regarding passive smoking issues in Area Health Services. The results of
the survey indicated that a majority of Health Services were either actively pursuing a
change in the previous smoking policy or were concerned that the existing smoking policy
required updating to address health and legal concerns.
As such, it was considered timely to revise the Department’s Smoke Free Workplace
Policy to ensure obligations under occupational health and safety legislation were being
met and to promote NSW Health as the provider of healthy workplaces and work
environments.
This policy will build on the 1988 Smoke Free Workplace Policy and has the goal of
prohibiting smoking throughout all property controlled by NSW Health, this includes
buildings, campuses and vehicles. Therefore the 1999 Policy will extend beyond the focus
of the previous policy on exposure to environmental tobacco smoke in indoor areas to
include exposure in outdoor areas. There will however be the possibility of limited
exempted outdoor areas during the implementation of the policy to meet the needs of
specific patients and or staff. The feasibility of the commencement of smoke free
campuses and facilities will be dependent on the outcome of the review undertaken during
Phase Three of the policy.
2. Rationale
The rationale for the updating of the Department’s Smoke Free Workplace Policy is to:
C reduce the harm associated with tobacco use amongst staff, patients, visitors and
the community, especially exposure to passive smoking;
C provide a clear and consistent message to staff, patients, visitors and the
community about the hazards of smoking;
C provide a clear and consistent message to staff, patients, visitors and the
community that smoking is not a healthy activity; and
C provide leadership in the community about reducing the harm associated with
smoking.
Smoke Free Workplace Policy 1999

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3. Policy Statement
The goal of the 1999 Smoke Free Workplace Policy is to prohibit smoking throughout all
buildings, vehicles, and property controlled by NSW Health. However, the Department is
mindful of:
C the diverse range of facilities and campuses which exist;
C the significant impact that this policy will have on many people including, patients,
staff, visitors and others;
C the need for an adequate time frame for the implementation of the policy;
C the need to ensure the flexible application of this policy; and
C the need to ensure the policy can be implemented at a local level and is supported
by staff and the community.
In recognition of these issues, the policy will be phased in over a period of two and half
years and will allow, during this period, for the possibility of limited exempted outdoor areas
where smoking is permitted, to meet the needs of specific patients and or staff.
Area Health Services, relevant unions and WorkCover Authority were consulted with in the
formulation of this policy.
4. Phases of the policy
4.1 Overview
The implementation of this policy comprises four phases. The first phase involves
extensive promotion and publicity concerning the change in policy, the development of an
Implementation Strategy by each Area Health Service, and the submission and
consideration of applications for exempted areas. This phase comprises the period from
1 March 2000 to 31 August 2000.
The second phase involves the introduction of smoke free campuses, but allows for the
possibility of limited outdoor exempted areas where smoking is permitted as determined
during the first phase. This phase will comprise the period from 1 September 2000 to 31
August 2001.

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The third phase entails a review of the implementation of the policy. Phase Three
comprises the period from 1 September 2001 to 31 August 2002.
The fourth phase involves the commencement of a total smoke free environment (indoor
and outdoor areas) from 1 September 2002, for all property under the control of NSW
Health.
Table: Phases of the Policy

Phase One Commencement of promotion and 1 March 2000 - 31 August 2000
publicity regarding the revised policy, the
development of an Area Health Service
Implementation Strategy, and
determination of exempted areas for
Phase Two (6 months)
Phase Two Introduction of smoke free campuses 1 September 2000 - 31 August 2001
with exemptions for nominated outdoor
areas (12 months)
Phase Three Review of Policy (12 months) and 1 September 2001 - 31 August 2002
preparation for smoke free public health
care facilities and campuses.
Phase Four Totally smoke free health care facilities, 1 September 2002 (pending the outcome of
campuses and vehicles under the control the review undertaken in Phase Three)
of NSW Health.
It is recognised that there are a number of key elements to the successful implementation
of this policy, of particular importance are:
C the provision of an appropriate promotion and education strategy for staff, patients,
visitors and the community;
C the provision of appropriate cessation and support programs for staff, patients,
visitors and others who work on NSW Health property;
C an appropriate enforcement strategy;
C appropriate signage; and
C appropriate disposal bins (during Phases One to Three) .
These are detailed further in Section Six.

The Department is mindful of the diverse range of facilities and campuses to which this
policy will apply and the need to ensure flexible application so that it can be implemented
at an Area Health Service level with support by staff and the community.

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4.2 Phase One: Development of an Implementation Strategy by Area Health
Services
1 March 2000 - 31 August 2000
To assist in the effective implementation of the 1999 Smoke Free Workplace Policy, Area
Health Services are required to develop an Implementation Strategy. The Strategy should
include an outline of the implementation process to ensure the policy is successful and is
supported by staff and the community. There are three components to this phase.
The first component involves the publicity and promotion of the policy. The second
component involves Area Health Services establishing a consultation and implementation
mechanism such as a working party to develop an Area implementation plan, manage the
Area consultation process and identify local issues relating to the policy. The third
component involves the preparation and submission of applications for exemptions to the
policy in preparation for the introduction in Phase Two of smoke free campuses.
The Chief Executive Officer (CEO) of each Area Health Service is responsible for ensuring
the implementation of the Department’s policies. However, to ensure the effective
implementation of this policy, it may also be necessary to assign responsibility to a senior
manager (eg Director of Human Resources or Health Promotion) to co-ordinate and
oversee the phases of implementation, and the monitoring and evaluation of the policy.
Component 1 Publicity and promotion
The implementation of this policy will require appropriate publicity and promotion strategies
to ensure broad support. The publicity and promotion should explain the objectives of the
Smoke Free Workplace Policy and the phases of the policy. The focus of these strategies
should be positive and focus on promoting the benefits of a smoke free environment for
staff, patients and visitors. The Department will undertake the development of an
appropriate education and information strategy for the promotion and publicity of this
policy. This will include the production of relevant posters, stickers and information
pamphlets and other resources.

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Component 2 Establishing the working party
The Department considers it essential that a consultative approach be adopted when

implementing this policy, and as such the development of a working party is considered a
necessary component of this implementation. When determining the composition of the
working party it is important that the relevant interest groups are represented to allow
appropriate consultation to occur. Previous experience indicates consultation is essential
to effective policy implementation.
In addition, some Area Health Services have expressed the need to establish
implementation committees at each health facility site rather than one working party for the
entire Area Health Service. This will be influenced by the organisation of the Area Health
Services and local preferences, however appropriate consideration should be given to a
co-ordinating mechanism across the Area Health Service if separate working parties are
to be established at each health facility site.
The role of the working party should be to:
1. Ensure consistent application of the policy across the Area Health Service.
2. Manage the consultative process at the Area Health Service level.
3. Oversee the implementation of the policy including Area Health Service support
strategies and activities that need to be undertaken.
4. Develop a local implementation strategy.
5. Identify the locality and rationale for exempted areas.
6. Consider applications for exempted areas and make recommendations on these
applications for the CEO’s information and decision.
The Area Health Service implementation strategy should address the:
C promotion and publicity component of the policy;
C recommendations for appropriate exempted outdoor areas;
C provision of a consultancy mechanism to assist local implementation committees;
C promotion and access to cessation services;
C design and provision of consistent signage across the Health Service;
C development of enforcement strategies; and
C establishment of a monitoring and evaluation mechanism including a reporting
mechanism to the CEO on the progress of the implementation of the policy.
It is recommended working party representatives and local implementation committee
members (non smokers and smokers) should be considered from the following areas:
C health service administration;
C relevant staff - health professionals, allied health professionals and non health
professionals ie security, cleaners and gardeners;
C unions;

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C occupational health and safety;
C mental health and alcohol and other drug services;
C health promotion;
C human resources;
C public affairs/media;
C heads of relevant clinical services;
C patient representatives;
C the community.
Component 3 Application for exemptions
It is recognised that until the commencement of totally smoke free campuses, exemptions
for nominated outdoor areas may need to be granted to address the particular needs of
specific patient groups and staff. It is the responsibility of the Area Health Service to
determine which localities will be nominated as exempted areas. Decisions on exempted
areas will need to be made by the CEO, on recommendations forwarded by the
Implementation Strategy Working Party, prior to 1 September 2000. Exemptions can be
granted for up to a maximum of 12 months and will not be valid beyond 31 August 2001.
As outlined further in Section 5, exemptions will only be permitted in nominated outdoor

areas which do not pose a health risk to other individuals and are a substantial distance
away from:
C ventilation intake shafts;
C entrances, doorways, enclosed verandahs and windows;
C food preparation and serving areas;
C hazardous substances and equipment.
This approach is consistent with advice from NSW WorkCover, determining that it is
necessary to ensure that risks from exposure to environmental tobacco smoke are
eliminated in each individual circumstance. As such, it is not possible to define an
optimum distance away from these areas that alleviates this risk.

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4.3 Phase Two: Introduction of a smoke free campus with exemptions
1 September 2000 – 31 August 2001
As of 1 September 2000, all Area Health Services are required to introduce smoke free
campuses. Smoking will only be permitted during this phase in nominated outdoor areas
where the CEO has granted an exemption. By the end of this phase, Area Health Services,
through their Implementation Strategy Working Party, will need to have reassessed all the
exemptions granted for Phase Two and determine whether these exemptions may continue
in their current form to Phase Three. The CEO must approve the continuation of these
exempted areas or their revision in accordance with Section 5.
4.4 Phase Three: Review of the policy
1 September 2001 - 31 August 2002
18 months after the commencement of this policy, the policy will be reviewed by the
Department in cooperation with the Area Health Services and health unions. The process
of the review will:
C examine the effectiveness of the implementation of the policy to date;
C examine the type, number of, and rationale for the exemptions granted; and
C identify the potential for NSW Health facilities and campuses to going totally smoke
free.
Smoking will only be permitted in nominated outdoor areas during Phase Three where it
has been agreed to by the CEO, on recommendations forwarded by the Implementation
Strategy Working Party, following a re assessment of all exemptions for that Area Health
Service during Phase Two.
4.5 Phase Four: Totally Smoke Free public health facilities and campuses
1 September 2002
As of 1 September 2002, it is the goal of this policy that smoking will not be permitted
anywhere on any property controlled by NSW Health, this includes buildings, campuses and
vehicles. The feasibility of the commencement of this phase of the policy will, however, be
dependent on the outcome of the review undertaken in Phase Three.

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5. Exemptions and flexible application of the policy
The goal of this policy is to extend the existing restrictions on smoking in NSW Health
buildings and vehicles to prohibit smoking on any property controlled by NSW Health.
However, it is recognised that during the implementation of the policy exemptions and
flexible application of the policy may be required for specific patient groups and staff.
5.1 Guidelines for exemptions
Exemptions can be considered only for outdoor areas. This is in recognition of previous
indoor smoking restrictions implemented with the introduction of the 1988 Smoke Free
Workplace Policy.
In applying for an exemption to this policy, a clear rationale and justification of why the
exemption is required must be outlined. Most importantly when considering the
establishment of an area exempted from the policy, it is paramount that the health and legal
risks posed to other patients, staff and visitors are addressed and that NSW Health is
promoted as a provider of healthy workplaces and environments.
The following issues must be considered by the implementation working party before
submitting recommendations regarding the establishment of exempted outdoor smoking
areas, to the CEO:
C proximity to dangerous goods and hazardous substances as cigarettes are a
source of ignition;
C proximity to doorways, windows, verandahs and air conditioning intakes or
situations where smoke has the opportunity to enter a building;
C proximity to food preparation areas;
C out of the physical view of the general public;
C availability of disposal bins;
C appropriate signage;
C appropriate lighting, physical safety and security of those using the area;
C accessibility of the area; and
C proximity to pedestrian thoroughfares.
The need for exemptions and the associated requirements will differ between Area Health
Services, therefore it is important to negotiate at a local level for exemptions. However, it
is important for Area Health Services to have a consistent policy. It is intended that
exemptions apply only during Phase Two and possibly with approval from the CEO (on
recommendations obtained from the Implementation Strategy Working Party) during Phase
Three of the policy implementation.

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As outlined previously, the review process undertaken in Phase Three of the policy will
examine the exemptions granted and determine the potential for the introduction of total
smoke free campuses for all NSW public health facilities.
It is essential that exempted areas are approved prior to the introduction of Phase Two of
the policy, namely the 1 September 2000 and that these exemptions are only valid until 31
August 2001. It is necessary that Area Health Services determine which exempted areas,
if any, they wish to continue during the review phase of the policy.
5.2 Staff
It is recognised that some Area Health Services may agree to exempt nominated outdoor
areas during Phase Two and possibly Phase Three, to address the particular needs of
specific staff. This is an issue for determination by the relevant working party and the CEO,
although the Health Service must consider its responsibility to promote healthy lifestyles
and practices.
The following criteria relate specifically to staff and exempted outdoor areas:
C staff wishing to smoke while at work are only to do so in award rest breaks (morning
tea, afternoon tea, lunch and dinner);
C exempted outdoor areas for staff are to be separate from patient and visitor
exempted areas;
C exempted outdoor areas for staff are to be out of view of the public.
It is the intention of this policy not to provide for exempted areas for staff after Phase Three
of the policy. The provision of exempted areas for staff will be assessed during the review
of the policy in Phase Three.
The Department encourages Health Services to ensure health promotion strategies and
smoke free policies contribute to improving the health of staff. Health Services are
encouraged to provide cessation support and advice to staff who wish to stop smoking.
5.3 Patients
It is recognised that some Area Health Services may agree to exempt nominated outdoor
areas during Phase Two and possibly Phase Three, to address the particular needs of
specific patients. This is an issue for determination by the relevant working party and the
CEO. Guidelines for exempted areas, as outlined in Section 5 will still apply. The
provision of exemptions will be assessed during the review of the policy.
The Department encourages Health Services to ensure health promotion strategies and
smoke free policies contribute to improving the health of patients. Health Services are
encouraged to provide cessation support to patients who wish to stop smoking.

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5.4 Community Health Employees
The Department has also been advised of concerns about the exposure of community
health employees to passive smoking during home visits for the provision of treatment to
patients who smoke. Information regarding the policy and health effects of passive
smoking should be made available to patients (eg patient information sheets) and included
on community health brochures. This should be done prior to the first home visit and
treatment session by community health care staff. Patients may be requested to refrain
from smoking in the presence of a community health employee when undergoing treatment.
If the patient does not refrain from smoking when requested by the community health
employee, treatment may be suspended until the patient has complied with the request.
Another treatment session on the same day may need to be organised to ensure the
patient's treatment regime is not compromised.
In the instance where patients refuse to comply with the request of the community health
employee, the matter should be referred to the manager of the community health care
service. The manager should contact the patient and discuss the incident and reiterate the
health effects of passive smoking and the smoke free policy.
5.5 Flexible Application of the Policy
The Department recognises some Area Health Services have already developed a Smoke
Free Workplace Policy for their campus. The Department supports these Health Services
where the following steps have been undertaken to develop and implement the policy:
C a consultative approach with relevant groups on campus;
C consideration has been given to public health issues concerning exposure to
tobacco smoke;
C consideration has been given to legal issues concerning exposure to tobacco
smoke (eg the NSW Occupational Health and Safety Act 1983); and
C the policy has been phased in over an adequate time period.
The Department supports Area Health Services who have introduced all or parts of this
policy in a more expedient manner.

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6. Important Implementation Components
6.1 Cessation Support
It is recognised this policy will have an impact on the staff, patients and visitors who smoke.
Many will not face any difficulties adhering to this policy, but some may find this difficult.
It is therefore important for Health Services to consider a range of options offering support
to those who wish to quit and those undergoing nicotine withdrawal. These may include
distribution of quit kits and promotion of a range of cessation interventions and programs
including nicotine replacement therapies.
Health Services are encouraged to provide brief intervention and cessation programs to
employees and patients. Many Health Services have advocated for and have utilised
nicotine replacement therapies for inpatients, and provided patients with patches to assist
with nicotine withdrawal where appropriate.
6.2 Enforcement Procedures & Disciplinary Action
6.2.1 Staff
The Department is committed to the implementation of the Smoke Free Workplace Policy.
Strategies which Health Services can use to ensure compliance include:
C education;
C publicity;
C the wide spread promotion of the policy;
C training for staff to deal with colleagues, patient and visitor non compliance; and
C disciplinary action.
Non compliance with this policy by staff should be managed in line with disciplinary
procedures established by Health Services.
Employees who breach the policy in the first instance, should be counselled by their
supervisor. The supervisor will explain the Department's policy and occupational health
and safety requirements, with the health effects of passive smoking on co-workers being
stressed. Enquiries will be made regarding whether the employee requires assistance to
stop smoking. The supervisor will direct the employee to an appropriate contact person
if they wish to stop smoking. A written record of the interview will be kept by the supervisor
but this will not be placed on the employee’s personal file.
If the staff member continues to breach the policy, the supervisor or manager will explain
that a formal disciplinary interview will take place and that this could lead to the termination
of employment. The structure of a disciplinary interview will be explained and also what the

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employee’s rights are during the hearing. Where disciplinary action is initiated against an
employee, there are established procedures which are designed to ensure the employee
concerned is afforded a fair hearing.
6.2.2 Patients, Clients and Visitors
To assist with ensuring the compliance of patients and visitors with the policy, it has been
the experience of Area Health Services that the prominent display of appropriate signage
and bins has been of benefit.
Staff may need to be trained so they can assist with the implementation of the policy. Area
Health Services are encouraged to have regular training sessions for staff to ensure the
policy can be enforced in a non-confrontational manner.
Non compliance with the policy by patients and visitors is to be dealt with in a non-
confrontational way by staff. Patients and visitors are to be reminded of the Health Service
smoke free policy. During Phase Two and Three areas where smoking is permitted should
be indicated.
Any further problems are to be referred to the Supervisor or Security. If further requests by
Security or the Supervisor fail to resolve the issue, the visitor may be requested to leave
and escorted from NSW Health property.
6.3 Grievance Procedures
Grievance about the policy or actions associated with the policy should follow established
Health Service or Departmental Grievance Procedure Guidelines.
Health Services are encouraged to have regular training sessions for supervisors, security
and other staff to ensure that the policy can be enforced in a non- confrontational manner.
6.4 Signage
Signs should be erected notifying staff, patients and visitors of the smoke free policy and
associated boundaries. Where necessary these should also be translated. They will
clearly outline the policy and identify where smoking is permitted during Phase Two and
Phase Three of the implementation of the 1999 Smoke Free Workplace Policy. Signs
should also indicate that the campus or health facility will be moving towards a totally
smoke free environment by the April 2002.

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6.5 Disposal Bins
Appropriate disposal bins should be installed on the Health Service campus to ensure
proper disposal of smoking paraphernalia.
6.6 Contract Services
Where the Department or Health Service contracts out services to be undertaken on

Department or Health Service property then the contract of engagement should stipulate
that the contractor will comply with the 1999 Smoke Free Workplace Policy.
6.7 Shared Office Accommodation
If Departmental employees share office accommodation on a property not owned by the

Department and a smoke free workplace policy does not exist, NSW Health employees
are encouraged to initiate discussions with other tenants aimed at achieving a smoke-free
working environment. The accommodation occupied by the Health Department employees
will be subject to this policy.
It is recommended that when new lease arrangements for shared buildings are to be
negotiated, consideration is given to whether a smoke-free working environment is being
actively promoted. Further, that as a condition of the lease, air conditioning units should
be free from tobacco smoke pollutants.
6.8 Contract of Employment
Advertisement for a position in the NSW Department of Health and Health Services will
include a statement to ensure people wishing to apply for jobs in the NSW public health
system are aware of the Smoke Free Workplace Policy. From the date of release of this
policy, job descriptions should include a statement to inform applicants of the smoke free
policy.
6.9 Leasing Agreements
Where the Department leases out property, (eg a coffee shop) the lessee is to be
responsible for ensuring the Department’s Smoke Free Workplace Policy is adhered to.
Health Services are encouraged to include this as a condition of on-going leasing
arrangements.

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As outlined in the 1988 Policy on Smoking in the Workplace, Health Services are reminded
that:
C no advertisements for cigarettes or other tobacco products should be displayed on
Health Department or Hospital premises; and
C tobacco products should not be for sale on those premises.
6.10 Building and Construction Agreements
Where the Department enters into a building and construction agreement, requirements
of the Smoke Free Workplace Policy should be included in the contract.
7. Policy Review
This policy will be reviewed during the period 1 September 2001 to 31 August 2002,
Phase Three of the policy, 18 months after the commencement of the policy. The review
will be managed by the Department, but require involvement and participation of Area
Health Services, health unions, staff, patients and visitors.
The review will:
C examine the effectiveness of the implementation of the policy to date;
C examine the type, number of, and rationale for the exemptions granted; and
C identify the potential for NSW Health facilities and campuses to go totally smoke
free.
Details of the review will be finalised during Phase Two in consultation with Area Health
Services, staff and unions.
7.1 Policy Evaluation Framework
An evaluation framework for the policy will be developed in consultation with Area Health
Services and health unions prior to the commencement of Phase One. The framework will
identify the mechanisms for monitoring the implementation phases of the policy. These
may include:
C Each Area Health Service, in consultation with the Implementation Working Party,
establishing a system for recording and monitoring the number of complaints from
staff, patients and visitors about smoking issues on campus. Such a system will
assist in identifying groups who may be experiencing difficulties with the policy so
that an appropriate strategy can be adopted to address these concerns. It is

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envisaged that the Department will assist Area Health Services in the development
and implementation of such a system, by facilitating discussions statewide on the
system, seeking agreement on a model system for promotion and use by Area
Health Services, and assisting with the printing of any necessary products to
support it.
C Each Area Health Service maintaining a register/list of all exemptions granted and
declined for Phase Two and Three and the rationale for each exemption.
C Each Area Health Service, through the Implementation Working Party, maintaining
a record of the strategies implemented to promote the policy, to inform staff,
patients and visitors regarding the policy and to support staff, patients and visitors
regarding cessation methods.
C Each Area Health Service maintaining a record of employee participation (statistics
only, not personal information) in cessation activities. Similarly maintaining a record
of the number of staff, patients and visitors who have utilised health service
cessation services, noting those people who stop smoking by the end of the course
and at a later follow up date.
C At the commencement and expiration of both Phase One and Phase Two,
conducting a survey of staff, patients and visitors in relation to implementation of that
particular phase. It is envisaged that a pro forma survey will be developed to ensure
consistency in surveying between Area Health Services and to reduce duplication
of resources and effort of each Area Health Service developing their own. Such a
pro forma will be developed in consultation with key stakeholders. It is envisaged
that the survey data collection and analysis will be undertaken by the Department
with Area Health Services and unions having a key role in the promotion and
implementation of the survey. The Department will be responsible for the collation
of this information and will provide this information back to Area Health Services.
The Area Health Services will be at liberty to include additional questions to reflect
specific issues regarding the implementation process at the local level ensuring this
is planned and implemented in consultation with relevant parties, and in particular,
the Area Implementation Working Party.
C Each Area Health Service nominating a representative or key contact (ideally a
member of the Implementation Working Party) for the monitoring, review and
evaluation of the policy.
C Each Area Health Service submitting a brief report on the status of implementation
of each phase of the policy (utilising the information collected through the above
monitoring processes) to the Tobacco Policy Unit, NSW Health Department.
The review of the policy occurring during Phase Three will comprise a significant
component of the evaluation framework. The suggested monitoring mechanisms, yet to
be discussed and agreed with relevant parties, would provide significant input for the
review.

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8. Key Definitions
consultation: the sharing of information and exchange of views

between managers, workers and/or their representatives
on health and safety issues. It includes the opportunity to
contribute to decision making in a timely fashion to
resolve smoking issues in the health workplace.
designated outdoor
smoking area: an outdoor area sign posted as a designated smoking
area.
environmental tobacco
smoke: a carcinogenic compound containing over 4,000
chemicals including 43 known carcinogens. It is a
combination of side-stream smoke and exhaled
mainstream smoke or second hand smoke.
health care facility: a place that treats health problems or employs health
care professionals and is part of NSW Health.
health service employee: a person appointed under the Health Administration Act
or the Public Service Act.
passive smoking: the inhalation of environmental tobacco smoke (ETS).
risk: the likelihood that harm will occur.
smoke free areas: all areas, other than those agreed to as designated
smoking areas will be smoke free.
smoke free workplace: a workplace where employees are not exposed to

side-stream smoke.
workplace: any place where an employee works, or is likely to work,

and includes any place that a person goes while at work
eg: hospitals, motor vehicles including ambulances, and
patient/clients homes.

17
SMOKE FREE WORKPLACE POLICY
IMPLEMENTATION MANUAL
1999
This work is copyright. It may be reproduced in
whole or in part for study or training purposes
subject to the inclusion of an acknowledgment
of the source and no commercial usage or sale.
© NSW Health Department 1999

State Health Publication No: (HP) 000002
ISBN: 07 3473 1299
Circular No: 99/76
December 1999
TABLE OF CONTENTS
SECTION ONE: BACKGROUND...................................................................................................... 1
Purpose of this Document .......................................................................................................... 2
Rationale for “Smoke Free - NSW Health” .................................................................................... 2
Health Issues relating to Passive Smoking ......................................................................... 2
Legal Issues Relating to Passive Smoking.......................................................................... 3
NSW Health as a Promoter of Health................................................................................. 3
What is the Policy ..................................................................................................................... 4
How the Policy was developed .................................................................................................... 5
Implementation of the Policy....................................................................................................... 6
SECTION TWO: PHASES OF IMPLEMENTATION........................................................................... 7
Introduction ............................................................................................................................... 8
Phase 1: Development of an Implementation Strategy by Area Health Services ............................... 8
Establishment of Consultation and Implementation Mechanisms .......................................... 9
Publicity & Promotion of the Policy.................................................................................. 10
Information Strategies for the General Community........................................................ 10
Information Strategies for Staff................................................................................... 11
Information Strategies for Patients.............................................................................. 12
Information Strategies for Public and Visitors .............................................................. 12
Preparation for the Designation of Exemptions .................................................................. 12
Exemptions and Criteria ............................................................................................. 13
Signage.................................................................................................................... 13
Disposal Bins............................................................................................................ 13
Phase 2: Introduction of a Smoke Free Campus with Exemptions ................................................ 14
Publicity and Promotion of Phase Two of the Policy .......................................................... 14
Monitoring of the Policy and its Implementation in Phase Two ............................................ 14
Preparation of Exemptions for Phase Three of the Policy ................................................... 14
Phase 3: Review of the Policy.................................................................................................. 15
Publicity and Promotion of Phase Three of the Policy ........................................................ 15
Exemptions ................................................................................................................... 15
Monitoring of the Policy in Phase Three............................................................................ 15
Phase Four: Totally Smoke Free .............................................................................................. 16
Publicity and Promotion of Phase Four of the Policy.......................................................... 16
Exemptions ................................................................................................................... 17
Monitoring of the Policy in Phase Four ............................................................................. 17
Training................................................................................................................................... 17
Policy Evaluation Framework .................................................................................................... 17
SECTION THREE: OPPORTUNITIES FOR PROMOTING CESSATION............................................ 20
Overview of Smoking Cessation................................................................................................. 21
Implications for Staff and Patients ............................................................................................. 21
Short Term Addiction Management .................................................................................. 21
Patients/Clients......................................................................................................... 21
Staff......................................................................................................................... 22
Long Term Cessation Opportunities ........................................................................................... 22
Patients and Promotion of Brief Intervention ................................................................ 22
Staff and Promotion of Brief Intervention ..................................................................... 23
Services to Smokers ................................................................................................. 23
SECTION FOUR: CASE STUDIES................................................................................................. 24
CENTRAL COAST AREA HEALTH SERVICE ............................................................................ 25
Rationale....................................................................................................................... 25
Process ........................................................................................................................ 25
Table of Implementation Phases ................................................................................ 25
Barriers / Problems Encountered & Solutions ................................................................... 26
Resources/ Communication Strategies............................................................................. 26
Worth A Mention............................................................................................................ 27
More Information ............................................................................................................ 27
SOUTH EASTERN SYDNEY AREA HEALTH SERVICE ............................................................. 28
Rationale....................................................................................................................... 28
Process ........................................................................................................................ 28
Barriers /Problems Encountered & Solutions .................................................................... 30
Worth A Mention............................................................................................................ 30
WESTERN SYDNEY AREA HEALTH SERVICE ........................................................................ 32
Rationale....................................................................................................................... 32
Process ........................................................................................................................ 32
Barriers /Problems Encountered & Solutions .................................................................... 34
SECTION FIVE: "SHELL" IMPLEMENTATION RESOURCES.......................................................... 36
Media Release - draft ............................................................................................................... 37
Brochure - staff........................................................................................................................ 38
Brochure - patients and visitors ................................................................................................. 40
Notice for Staff and Patient Bulletin Boards ................................................................................ 42
Sample Letter for Employees .................................................................................................... 43
Editorial for Patient and Client Newsletters and Public Information Brochures ................................ 45
Signage .................................................................................................................................. 47
SECTION SIX: REFERENCES ..................................................................................................... 48
SECTION ONE: BACKGROUND
Purpose of this Document
The purpose of this document is to provide supporting information regarding the

NSW Health Department 1999 Smoke Free Workplace Policy and to assist with
the implementation of this Policy at the Health Service level.
Smoking is recognised as the largest preventable cause of death in Australia.

Based on a large number of reports and studies (over 57,000) smoking has
been identified as a major cause of heart disease, stroke, several different forms
of cancer, as well as a variety of other health problems1. It is estimated to have
caused 18,920 deaths in Australia in 19922. The majority of deaths caused by
smoking occur through the development of coronary heart disease, lung cancer
followed by chronic bronchitis, stroke, peripheral vascular disease and other
circulatory diseases, and cancers other than lung cancer 3.
The rationale for the development of the Smoke Free Workplace Policy is:
• to reduce the harms associated with tobacco use amongst staff, patients and
visitors, especially exposure to passive smoking;
• to provide a clear and consistent message to the community about the
hazards of smoking;
• to provide a clear and consistent message to the community that smoking is
not a normal activity nor is it a healthy activity;
• to provide leadership in the community about reducing the harms associated
with smoking.
NSW Health needs to be seen as taking a united, proactive, best practice

approach to health initiatives, and the 1999 Smoke Free Workplace Policy is an
example of this.
Health Issues relating to Passive Smoking
Research on passive smoking over the past two decades has indicated that it
has a significant effect on the health of non-smokers’ and poses a particular
danger to the respiratory health of young children. Passive smoking is defined
as the inhalation of environmental tobacco smoke (ETS) which is a combination
of side-stream smoke and exhaled mainstream smoke or second - hand
tobacco smoke. The US Environmental Protection Authority has analysed side-
stream smoke and found that it contains significantly higher concentrations of
ammonia, benzene, nicotine, carbon monoxide than does the smoke inhaled by
an active smoker as this side-stream smoke is unfiltered.
Smoke Free Workplace Policy Implementation Manual

2
ETS is a carcinogenic compound that contains more than 4,000 chemicals
including 43 known carcinogens. Research has identified the following effects of
passive smoking in the short term, including eye irritation, coughing, headaches,
reduced lung function in asthmatic non smokers, reduced attentiveness and
problem solving ability and increased agitation. Long term effects include lung
cancer, pneumonia, increased risk of lung damage in adult non smokers,
increased serious respiratory illnesses such as bronchitis and pneumonia in
children whose parents are smokers, slower lung growth and poorer lung function
in young children whose parents smoke and coronary heart disease.
Legal Issues Relating to Passive Smoking
The NSW Occupational Health and Safety Act 1983 requires employers to
provide a safe working environment to ensure that employees and others are not
exposed to health risks while at work.
Before the mid 1980s litigation to obtain compensation for people affected by
passive smoking was unheard of and active smoking cases were largely
unsuccessful4. However, there has been increasing emphasis on the legal
ramifications of passive smoking in the workplace, supported by the emergence
of scientific evidence on the harmful effects of passive smoking.
Since 1985 there have been over twenty cases where employers have been
successfully sued in relation to passive smoking 5. A survey conducted by The
National Heart Foundation6 found that 27% of large businesses who have
introduced workplace bans as of December 1994 did so due to legal concerns.
This is an increase from 10% of workplaces with smoking bans in 1990. In
addition, a number of private actions have been successfully brought by
employees for compensation for harm caused by environmental tobacco smoke
in the workplace.
NSW Health as a Promoter of Health
NSW Health has the aim of improving the health of the people of New South
Wales so that it is equal to the best in the world. One of its principal goals for the
NSW Health system is:
“ensuring better health for people”
It is within this framework, that NSW Health has a responsibility to display

leadership and promote health not only in the provision of services but also in the
provision of healthy public places, including health campuses.
Health care institutions are highly visible and therefore have a responsibility to
ensure that health promotion strategies such as smoke free workplace policies

3
contribute to improving the health of those that come into contact with these
institutions. Health care facilities also have a responsibility to implement and
monitor a smoke free workplace policy. The Area Health Service Act 1986
states that a primary objective of Area Health Services is
“to promote, protect and maintain public health....” (s.19)
It is well documented that hospital and health facility policies regarding smoking
can positively effect the smoking habits of employees, patients and visitors7.
Research evidence suggests that hospitals that have a non smoking policy are
well accepted by patients and may have a favourable impact on patients’
smoking behaviour 8. There is also evidence that smoke-free workplace policies
are associated with a significant reduction in tobacco consumption by
employees and increased attempts at cessation by smokers, and that these
smoking restrictions can assist in improving employee health9.
This impact is due to the fact that workplaces with smoke-free policies provide
the longest smoke free period of time for the greatest number of people.
Further, smoke-free hospitals create an environment that supports cessation for
patients who smoke. For example, inpatient smoking cessation services could
be an opportune time to provide cessation interventions for patients10.
All health workers have a significant role in promoting health across a broad
range of health issues, service provision contexts and levels of intervention –
including primary prevention, clinical intervention, information, role modelling.
For example, nurses are the largest group of health care professionals in the
NSW health care system. They work with individuals and families in more health
care and community settings than any other group of providers. They are in a
position to promote the advantages of a smoke free environment and clarify risk
information for patients. The Australian Medical Association recognises that all
health professionals have a responsibility, by example, to encourage non
smokers to remain non smokers, and to encourage smokers to quit11. The
Smoke Free Work Place Policy 1999 also recognises that all personnel who
work in the health system have a very important role to play in the front lines of
health promotion.
What is the Policy
The goal of the 1999 Smoke Free Workplace Policy is to prohibit smoking
throughout all buildings, vehicles, and property controlled by NSW Health.
However, the Department is mindful of:
• the diverse range of facilities and campuses which exist;
• the significant impact that this policy will have on many people including,
patients, staff, visitors and others;

4
• the need for an adequate time frame for the implementation of the policy;
• the need to ensure the flexible application of this policy; and
• the need to ensure the policy can be implemented at a local level and is
supported by staff and the community.
How the Policy was developed
The Department has had a policy to reduce exposure to passive smoking on

Department property since 1984. In 1988 this policy was amended to reflect
concerns about the health effects of passive smoking and to incorporate the
requirements of the NSW Occupational Health and Safety Act 1983. The
revised policy was issued as Circulars - 88/118 Policy on Smoking in the
Workplace and 88/244 Department of Health NSW Policy on Smoke Free
Working Environment. The Department adopted this policy to ensure that an
atmosphere free of tobacco smoke would be regarded as the workplace norm.
As stated in the policy,
“The general aim of the policy was to ensure that a safe environment be
provided so that all staff, clients, patients and visitors are protected from
the health hazards and discomfits associated with exposure to tobacco
smoke in all public health facilities in NSW.”
The 1988 policy focused on the obligations of the Department to provide a

smoke free working environment following common law cases concerning the
effects of passive smoking. The policy noted the responsibility of employers to
provide a workplace free from hazards to air quality under the NSW
Occupational Health and Safety (OHS) Act 1983.
The 1988 policy also acknowledged the Department’s role in the promotion of
healthy lifestyles and practices. The Area Health Services Act 1986 states a
primary objective of an Area Health Service is (s.19) “to promote, protect and
maintain public health....”, as such it is recognised that the Department and
Health Services have a role in the promotion of health. The promotion of smoke
free policies and other related health promotion strategies in health care
facilities is an essential component in protecting the health of those who come
into contact with these institutions.
The 1988 Smoking Policy imposed a ban on smoking by all staff, patients and
visitors within Health Department buildings and vehicles owned by the
Department. This included buildings and vehicles of public hospitals, Area
Health Services and associated organisations.

5
In early 1997, the Department conducted a survey on the status of the 1988
Smoking Policy and concerns regarding passive smoking issues in Area Health
Services. The results of the survey indicated that a majority of Health Services
were either actively pursuing a change in the previous smoking policy or were
concerned that the existing smoking policy required updating to address health
and legal concerns.
As such, it was considered timely to revise the Department’s Smoke Free

Workplace Policy to ensure obligations under occupational health and safety
legislation were being met and to promote NSW Health as the provider of
healthy workplaces and work environments.
This policy will build on the 1988 Smoke Free Workplace Policy and has the
goal of prohibiting smoking throughout all property controlled by NSW Health,
this includes buildings, campuses and vehicles. Therefore the 1999 Policy will
extend beyond the focus of the previous policy on exposure to environmental
tobacco smoke in indoor areas to include exposure in outdoor areas. There will
however be the possibility of limited exempted outdoor areas during the
implementation of the policy to meet the needs of specific patients and or staff.
The commencement of smoke free campuses and facilities will be dependent on
the outcome of the review undertaken during Phase Three of the policy.
Implementation of the Policy
The implementation of the 1999 Smoke Free Workplace Policy comprises four
phases. The first phase involves extensive promotion and publicity concerning
the change in policy, the development of an Implementation Strategy by each
Area Health Service, and the submission and consideration of applications for
exempted areas. This phase comprises the period from 1 March 2000 to 31
August 2000.
The second phase involves the introduction of smoke free campuses, but allows
for the possibility of limited outdoor exempted areas where smoking is permitted
as determined during the first phase. This phase will comprise the period from 1
September 2000 to 31 August 2001.
The third phase entails a review of the implementation of the policy. Phase
Three comprises the period from 1 September 2001 to 31 August 2002.
The intention of the fourth phase of the implementation of the 1999 Smoke Free
Workplace Policy is the commencement of a total smoke free environment
(indoor and outdoor areas) from 1 September 2002, for all property under the
control of NSW Health. The implementation of this phase of the Policy will be
dependent upon the outcome of the review in Phase Three.

6
SECTION TWO: PHASES OF IMPLEMENTATION
Introduction
As outlined in the 1999 Smoke Free Workplace Policy document, the Policy will
be implemented by Health Services in four phases:
Phase One Commencement of promotion and 1 March 2000 – 31 August 2000

publicity regarding the revised policy,
the development of an Area Health
Service Implementation Strategy, and
determination of exempted areas for
Phase Two (6 months)
Phase Two Introduction of smoke free campuses 1 September 2000 – 31 August
with exemptions for nominated outdoor 2001
areas (12 months)
Phase Three Review of Policy (12 months) and 1 September 2001 – 31 August
preparation for smoke free public health 2002
care facilities and campuses
Phase Four Totally smoke free health care 1 September 2002 (pending the
facilities, campuses and vehicles under outcome of the review undertaken in
the control of NSW Health Phase Three)
Critical to the success of the Policy’s phased implementation is the development

and implementation of a strategy to support the Policy’s introduction at the
Health Service level.
The Chief Executive Officer of an Area Health Service may wish to delegate
responsibility for the Policy’s implementation to a unit within the Health Service,
for example, Human Resources, Health Promotion and/or an officer they deem
appropriate. It is also recommended that an Area Health Service
Implementation Strategy be developed to assist in the Policy’s implementation.
The following section provides information and advice on the strategies which
Health Services may choose to support the Policy’s implementation in each
phase.
Also provided in this implementation package is information on case studies

from Health Services who have already commenced work on the introduction of
a Smoke Free Workplace Policy. These case studies have been provided by:
• Central Coast Area Health Service;

• South Eastern Sydney Area Health Service;
• Western Sydney Area Health Service.
The case studies provide information on implementing the Policy at a local level.
Phase 1: Development of an Implementation Strategy

8
by Area Health Services
To assist in the effective implementation of the 1999 Smoke Free Workplace

Policy, Area Health Services should consider the development an
Implementation Strategy. The Strategy should include an outline of the
implementation process to ensure the policy is successful and is supported by
staff and the community. There are three components to this first phase.
1. establishment of a consultation and implementation mechanism such as a
working party to develop an Area implementation plan, manage the Area
consultation process and identify local facility issues relating to the policy;
2. publicity and promotion of the policy;
3. preparation and submission of applications for exemptions to the policy in
readiness for the introduction in Phase Two of smoke free campuses.
It is also recommended that an Area Health Service Implementation Strategy

provide for the ongoing feedback and collation of information which will be
required during periods of policy review. It is envisaged that the Department will
be identifying an evaluation framework in consultation with Area Health Services
and relevant unions to assist in the policy review and this will be available prior to
the commencement of the second phase.
The Policy provides information on compliance management and breaches.

Area Health Services are encouraged to develop a compliance and grievance
policy in line with this and existing Health Service policies. This should
incorporate a feedback mechanism to ensure information is collated to feed into
periods of policy review. It is recommended that appropriate information and
training is provided for those responsible for enforcement of the Policy to ensure
they have appropriate skills for handling compliance enforcement issues.
Establishment of Consultation and Implementation

Mechanisms
As outlined previously, the Chief Executive Officer of an Area Health Service

may wish to delegate responsibility for the Policy’s implementation to a unit
within the Health Service, for example, Human Resources, Health Promotion
and/or an officer they deem appropriate.
It is also recommended that an Area Health Service working group be formed,

comprising of members from relevant areas within the Health Service to assist in
implementation. The role of the working group should encompass:
• ensuring consistent application of the policy across the Health Service;

• managing the consultative process at Health Service level;
• overseeing the implementation of the policy including local support strategies
and activities that need to be undertaken;

9
• developing an Area Health Service implementation strategy and
• monitoring the implementation of the Policy.
Dependent upon the make up of the Area Health Service, it may be worthwhile
for Area Health Services to consider the establishment of local facility
implementation working groups to assist in the implementation of the 1999
Smoke Free Workplace Policy within certain sites and facilities.
Publicity & Promotion of the Policy
Critical to ensuring acceptance of, and compliance with, the Policy, is the
promotion and provision of information on the Policy and its implications to the
range of groups it will affect. These groups include:
• general community;
• staff;
• patients/clients;
• visitors.
Information should also be made available regarding options for people who
wish to quit or those who wish to manage their nicotine dependence in the health
service setting.
Area Health Services will need to ensure that information is made accessible for
members of the local community and health workforce with special needs -such
as people with low literacy, visual impairment or from culturally & linguistically
diverse backgrounds. This may mean providing information in a range of
formats and languages.
Information Strategies for the General Community
The implementation of information strategies targeting the general community

provides an opportunity to raise general community awareness of the Policy.
More specifically it provides an effective means to target patient/client and visitor
groups prior to their visit to a health campus and therefore support the more
direct information strategies outlined below.
It is recommended that a simple media strategy is implemented targeting the

local media prior to and during the phases the Policy’s introduction. A shell
media kit is contained in the Supporting Resources Information to assist in doing
this. This kit can be used in its current form or adapted to incorporate local
issues and angles.
Health Service Public Affairs Officers or Quit key contacts may be able assist in
the delivery of local media strategies and/or provide advice on related issues.

10
Health workers from specific communities, for example from a non-English
speaking background (NESB), could assist with placement of articles in NESB
press and radio.
Information Strategies for Staff
Staff potentially represent the largest group affected by the Policy and require
ongoing information throughout the Policy’s phased implementation.
Health Services are encouraged to identify the communication channels routinely

used to communicate with staff in their Area and to utilise these to disseminate
information on the Policy.
Whilst staff communication will vary from to Health Service to Health Service,
particular strategies could include:
• provision of a letter from CEO to accompany pay slips prior to the Policy’s
introduction notifying staff of the policy and exempted areas;
• ensuring the incorporation of the policy into staff orientation programs and
staff manuals;
• wide dissemination of area maps indicating where smoking is permitted (this
could accompany the letters from CEOs);
• placement of information and maps on staff bulletin/notice boards;
• inclusion of information in staff newsletters;
• recognition that the implementation of the policy may create difficulties for
some staff;
• encouragement of staff who do not smoke to assist their colleagues through a
potentially difficult stage;
• offer support for staff who will need to manage their nicotine dependence at
work;
• provide information of the availability of smoking cessation initiatives;
• recognition of health promotion role of all health workers
• intranet to publicise and provide information to staff particularly in relation to
the components of the policy and smoking cessation assistance.
To assist in the delivery of information to staff, a range of documents have been

developed for local use and are contained in Supporting Resources Information.
Area Health Services may wish to consider translating such materials into
relevant language categories or other formats for members of the local
community and health workforce with special needs – such as people with low
literacy, visual impairment or from culturally & linguistically diverse backgrounds.
Signage will also play a key role in supporting the strategies identified above
with experience to date indicating that clear, adequate and prominent signage
plays an important role in ensuring compliance with this Policy.

11
Information Strategies for Patients
Determining the most effective manner to communicate the Policy and its
implications will depend upon the type of service required.
Elective Patients: it is recommended that information on the policy

accompany other pre-admission information provided to all
elective patients.
Non-elective Patients: it is recommended that the smoking status of non-

elective patients be ascertained via admission
forms and that information is provided to smoking
patients on the requirements of the non smoking
policy and where assistance may be obtained.
To assist in the provision of information for patients, an information resource is

contained in Supporting Resources Information.
General awareness amongst all staff will assist patients/clients who require more
information regarding the restrictions on smoking. As with all other groups,
prominent signage is also key to ensuring patients are aware of designated
outdoor areas.
Information Strategies for Public and Visitors
Placement of prominent signage provides the most effective mechanism to

ensure those affected by the Policy for short periods of time are aware of their
responsibility when visiting health facilities.
General awareness amongst all staff will assist the public and visitors who
require more information regarding the smoking restrictions. Placement of
signage is supported by the general community strategy outlined above.
Preparation for the Designation of Exemptions
As stated in the Policy, there is a need for the flexible application of the policy
and it is recognised that until the commencement of totally smoke free
campuses, exemptions for nominated outdoor areas may need to be granted to
address the particular needs of specific patient groups and staff. It is the
responsibility of the Area Health Service to determine which localities will be
nominated as exempted areas. Decisions on exempted areas will need to be
made by the Chief Executive Officer, on recommendations forwarded by the
Implementation Strategy Working Party, prior to 1 September 2000.
Exemptions can be granted for up to 12 months and will need to be reassessed
at the end of this time to assess the feasibility of the exemption continuing during
the review phase.

12
Exemptions and Criteria
It is recommended that those responsible for the Policy’s implementation first

establish clear criteria against which proposed exempted areas can be
assessed. These criteria should be in keeping with those issues identified in the
policy under ‘Guidelines for Exemptions’. It is also recommended that
comprehensive documentation is retained on the process of exemptions, to
assist in the review at a later stage.
Signage
Given the existence of both exempted and smoke free areas in the introductory
phases of the Policy, signage plays an important role in ensuring that people are
aware of those areas where smoking isn’t permitted. It is considered useful to
outline the exempted areas on maps etc that may be located on notice boards
around the campus.
In the enclosed Supporting Resources document, suggested wording for

signage that may be adapted by Health Services is provided.
Disposal Bins
The Policy requires the installation of appropriate disposal bins to ensure the
proper disposal of smoking paraphernalia. These should be placed in
exempted areas once designated.

13
Phase 2: Introduction of a Smoke Free Campus with
Exemptions
This phase of the Policy’s implementation incorporates the introduction of a

Smoke Free Campus with exempted outdoor areas where smoking is permitted.
It involves the explicit communication of those areas where smoking is allowed to
those persons affected by the Policy. It also involves the ongoing monitoring and
evaluation of the implementation of the Policy.
Publicity and Promotion of Phase Two of the Policy
With the commencement of Phase Two and the introduction of a smoke free
campus with exemptions, it is important that the general community, staff,
patients, the public and visitors are informed that the Policy is now in place.
Those information strategies identified in the previous section titled “Publicity

and Promotion of the Policy” should be used for ongoing communication with
staff and other relevant groups to remind them of their obligations and
progression of the Policy’s phased implementation.
It is recommended that regular reminder strategies are employed to reinforce the

Policy. For example, including an article in the staff newsletter every six months
or a flyer for staff, patients and visitors on the canteen notice board. Reminder
strategies should also flag the forthcoming introduction of totally smoke free
campuses in the Policy’s final phase. This will help to ensure a smooth
transition, by ensuring that there is awareness of the policy’s long term
progression and implications.
Monitoring of the Policy and its Implementation in Phase

Two
It is expected that the Area Health Service Smoke Free Workplace

Implementation Plan and the Working Party will identify monitoring processes
with the Policy and its implementation phases. During this phase of the Policy
these compliance and evaluation mechanisms should be implemented and
managed on an ongoing basis.
Preparation of Exemptions for Phase Three of the Policy
As outlined previously the exemptions granted for phase two of the Policy are
only intended to be for the duration of this phase of the Policy, namely one year.
The Implementation Working Party should re assess the exemptions granted
during this phase of the Policy and make recommendations to the Chief
Executive Officer on whether these exempted areas should continue during
Phase Three.

14
Phase 3: Review of the Policy
18 months after the commencement of this policy, the policy will be reviewed by
the Department in cooperation with the Area Health Services and health unions.
The process of the review will:
• examine the effectiveness of the implementation of the policy to date;
• examine the type, number of, and justification for the exemptions granted; and
• assess the potential for NSW Health facilities and campuses to going totally
smoke free.
Publicity and Promotion of Phase Three of the Policy
Again, it is recommended that regular reminder strategies are employed to

reinforce the policy, particularly amongst staff, and encourage their contribution
to the review of the policy and its effectiveness. It may also be worth highlighting
that one of the key issues that will be addressed by the review process will be
identifying the potential for NSW Health facilities and campuses to going totally
smoke free.
Exemptions
Phase Three includes reassessment of all exemptions for the Area Health
Service granted during Phase Two. Smoking will only be permitted in
designated outdoor areas during Phase Three after this reassessment,
recommendations from the Implementation Working Party and agreement by the
CEO.
The review criteria specifically in relation to exempted Areas will include:
1. how many exemptions granted in the Area

2. what specific area/facilities were granted exemptions
3. what were the criteria used for granting exemptions
4. what was the response to exemptions by staff/visitors/patients
5. what difficulties were experienced in designation of, and enforcing
exempted areas.
Monitoring of the Policy in Phase Three
As identified above Chief Executive Officers (CEOs) will be required to provide

feedback on the Policy and its implementation in Phase Three.
In reviewing the Policy, CEOs will be asked to comment on issues relating the
process of the review, including:

15
• the effectiveness of the implementation of the policy to date;
• the type, number of, and rationale for the exemptions granted; and
• the potential for NSW Health facilities and campuses to become totally smoke
free.
CEOs will also be asked to provide feedback on the implementation of the policy
and assistance provided to Health Services with its implementation. This will
include feedback on:
• the usefulness of the Implementation Package and assistance provided by the

Department;
• aids to implementation;
• barriers to implementation.
Further information on the evaluation framework, collation and timing of feedback

will be provided for Phase 2.
Phase Four: Totally Smoke Free
As of 1 September 2002, it is the goal of this policy that smoking will not be
permitted anywhere on any property controlled by NSW Health, this includes
buildings, campuses and vehicles. The feasibility of the commencement of this
phase of the policy will, however, be dependent on the outcome of the review
undertaken in Phase Three.
Publicity and Promotion of Phase Four of the Policy
Utilising those information mechanisms identified in Section 2.2, staff, patients

and visitors should be made aware of the introduction of the Smoke Free
Workplace Policy and obligations arising from its ongoing implementation.
Particular attention needs to be paid to exempted areas which are changing to
smoke free areas at Phase Four.
The introduction of complete smoking bans has implications in relation to both

short term addiction management, the utilisation of Nicotine Replacement
Therapy and the provision of brief interventions. Section Three of this Manual,
‘Opportunities for Promoting Cessation’, focuses in more detail on some of
these issues. The case studies in Section Four of this Manual provide
examples of strategies that other Area Health Services have developed to
address issues relating to smoking cessation and addiction management.

16
Exemptions
The designation of exemptions during this phase, will be dependent on the

outcome of the review undertaken in Phase Three.
Monitoring of the Policy in Phase Four
Health services should continue to collate information in relation to the success

of the implementation of the Policy. Further information in relation to monitoring
and evaluation will be provided with the distribution of an evaluation framework.
Training
To assist in the implementation and enforcement of the NSW Health

Department’s Smoke Free Workplace Policy it is essential to ensure that ALL
staff are aware of the restrictions posed by the Policy. However, it is also
necessary to ensure that relevant staff who are charged with the responsibility of
enforcing the policy are appropriately trained.
Training should include the following key elements:
• components of the Policy, including the phase in dates, and areas where
smoking is still permitted;
• appropriate steps in dealing with non compliance in a non confrontational
manner;
• awareness of the Health Service’s grievance procedures.
Training needs may change during implementation and evaluation of the Smoke
Free Workplace Policy. Ongoing awareness of and response to training needs
will be required throughout the phases of implementation.
Policy Evaluation Framework
Evaluation has an important role in the development, implementation and on-

going maintenance of the 1999 Smoke Free Workplace Policy. There is
increasing recognition of the importance of evaluating policy at both
Departmental and Area levels to establish if the policy is achieving its objectives.
For example the review process undertaken to update this Policy included:
• collation of information from other States in Australia on smoke free

workplace policies;
• survey of Health Services to identify issues concerning the 1988 Smoking

17
Policy. The results of the survey indicated that many Health Services did have
issues that were not adequately addressed by the 1988 Policy and had
developed an extended policy to address these concerns.
An evaluation framework for the policy will be developed in consultation with

Area Health Services and health unions prior to the commencement of Phase
Two. The framework will identify the mechanisms for monitoring the
implementation phases of the policy. These may include:
• Each Area Health Service, in consultation with the Implementation Working

Party, establishing a system for recording and monitoring the number of
complaints from staff, patients and visitors about smoking issues on campus.
Such a system will assist in identifying groups who may be experiencing
difficulties with the policy so that an appropriate strategy can be adopted to
address these concerns. It is envisaged that the Department will assist Area
Health Services in the development and implementation of such a system, by
facilitating discussions state wide on the system, seeking agreement on a
model system for promotion and use by Area Health Services, and assisting
with the printing of any necessary products to support it.
• Each Area Health Service maintaining a register/list of all exemptions granted

and declined for Phase Two and Three and the rationale for each exemption.
• Each Area Health Service, through the Implementation Working Party,

maintaining a record of the strategies implemented to promote the policy, to
inform staff, patients and visitors regarding the policy and to support staff,
patients and visitors regarding cessation methods.
• Each Area Health Service maintaining a record of employee participation

(statistics only, not personal information) in cessation activities. Similarly
maintaining a record of the number of staff, patients and visitors who have
utilised health service cessation services, noting those people who stop
smoking by the end of the course and at a later follow up date.
• At the commencement and expiration of both Phase One and Phase Two,
conducting a survey of staff, patients and visitors in relation to implementation
of that particular phase. It is envisaged that a pro forma survey will be
developed to ensure consistency in surveying between Area Health Services
and to reduce duplication of resources and effort of each Area Health Service
developing their own. Such a pro forma will be developed in consultation with
key stakeholders. It is envisaged that the survey data collection and analysis
will be undertaken by the Department with Area Health Services and unions
having a key role in the promotion and implementation of the survey. The
Department will be responsible for the collation of this information and will
provide this information back to Area Health Services. The Area Health
Services will be at liberty to include additional questions to reflect specific

18
issues regarding the implementation process at the local level ensuring this is
planned and implemented in consultation with relevant parties, and in
particular, the Area Implementation Working Party.
• Each Area Health Service nominating a representative or key contact (ideally

a member of the Implementation Working Party) for the monitoring, review
and evaluation of the policy.
• Each Area Health Service submitting a brief report on the status of

implementation of each phase of the policy (utilising the information collected
through the above monitoring processes) to the Tobacco Policy Unit, NSW
Health Department.

19
SECTION THREE: OPPORTUNITIES FOR
PROMOTING CESSATION
Overview of Smoking Cessation
Tobacco products, due to their nicotine content, are classified as addictive

substances. As such the vast majority of smokers are addicted or heavily
dependent to their tobacco use. This dependence on cigarettes is the result of a
combination of factors which include:
• the social/psychological aspects, where smoking is associated with certain

situations;
• the physical aspect where smokers develop varying degrees of dependence
on nicotine.
The nature of dependence means that there may be a number of smokers who
will have difficulty abstaining for extended periods of time whilst on health
facilities. As such Health Services will need to consider:
• a range of options offering support to those who wish to quit;

• initiatives to support those undergoing nicotine withdrawal but who may not
wish to quit;
• that brief interventions for current smokers who are utilising a health service
can have favourable quitting results;
• that it is an opportunity to promote cessation as a component of a healthy
lifestyle.
Implications for Staff and Patients
Short Term Addiction Management
Patients/Clients
It is anticipated that the majority of patients/clients will have the opportunity to

plan for a non smoking stay in hospital through information provided about the
Policy. They will be able to contact their local health professionals for advice or
assistance with nicotine replacement therapies and other cessation techniques,
if required. As detailed earlier, Area Health Services may have the opportunity
to promote this type of intervention in any pre admission information provided to
patients.
For patients/clients who are accessing health facilities spontaneously and there
is no opportunity for the provision of information prior to this time, it is considered
necessary for health professionals to detail the requirements of the policy and
offer assistance to cope with nicotine withdrawal. This may include offering

21
alternatives to smoking during their stay, such as nicotine replacement therapies.
This will be a decision of the Area Health Service.
Staff
It is expected that the majority of staff will not find it difficult to comply with the
policy given adequate notice and appropriate prompting. However, strategies
should be identified to assist those within the workplace who experience
difficulties coping with short term nicotine withdrawal during work hours but who
do not intend to quit. Examples of such assistance already provided by some
Health Services include the provision of rebates for Nicotine Replacement
Therapy by the Area Health Service used during business hours.
Long Term Cessation Opportunities
As previously outlined in Section One, NSW Health has a responsibility to

display leadership and promote health:
• in the provision of cessation services;
• in the provision of smoke free public places; and
• in the promotion of smoke free lifestyles for both staff and patients.
The introduction of the NSW Health Smoke Free Workplace Policy provides an
opportunity for Area Health Services to actively promote smoking cessation for
individual and public health benefit by providing for the better health.
Patients and Promotion of Brief Intervention
Australian studies have found that:

• there is a preference among potential quitters for advice and programs
conducted through their doctor or another health professional
• there is a small but significant increase in cessation where doctors have, in
the course of consultation, given smokers brief quitting advice and simple
resource material;
• the most reliably effective intervention programs in the physician/health
professional setting are those providing firm, consistent and repeated help
and advice to stop smoking 12.
As this research indicates, the promotion of brief intervention for current smokers
who are utilising a health service can have favourable quitting results. Area
Health Services may wish to take this opportunity to identify the instances where
brief intervention for tobacco cessation can be provided.
It may also be necessary for Area Health Services to provide patients with
appropriate support to assist in the quitting process. Examples include
provision of cessation resources and literature, promotion of the Quitline or

22
locally run quitting groups, and delivery of Nicotine Replacement Therapy, if
appropriate, to patients unable or unwilling to access other cessation services.
Staff and Promotion of Brief Intervention
It is necessary for Health Services to provide appropriate support for staff

wishing to quit smoking. Examples of the types of support that have been
successfully implemented at an Area Health Service level include:
• Rebates or subsidies for staff by local facilities or the Area Health Service
who joined quit groups or used other recognised quitting methods such as
Nicotine Replacement Therapies;
• The provision of one months free supply of Nicotine Replacement Therapy to
assist staff with the assessment provided through hospital pharmacies.
• Provision of quitting services during work hours eg: brief intervention;
• Referral to appropriate counselling source eg: Drug and Alcohol Counsellors
or local GPs;
• Recognised leave for attendance at cessation services during working hours.
Services to Smokers
The literature reveals that 90% of smokers successfully quit with minimal
interventions or assistance. However, it is recognised that it is necessary to
provide a range of cessation support to assist those wishing to quit and who
require assistance. This may include increasing the awareness of staff, patients
and visitors to existing resources such as the Quitline (131848), Quit Kits, self
help groups, Quit pamphlets, local GPs, and the Alcohol and Drug Information
Service (ADIS).

23
SECTION FOUR: CASE STUDIES
CENTRAL COAST AREA HEALTH SERVICE
Rationale
The rationale for the introduction of a revised smoke free policy in the Central
Coast Area Health Service, included:
• reduce the harm associated with tobacco use amongst staff, patients, visitors
and the community, especially exposure to passive smoking.
• provide a clear and consistent message to staff, patients, visitors and the
community about the hazards of smoking;
• provide a clear and consistent message to staff, patients, visitors and the
community that smoking is not a healthy activity; and
• provide leadership to the community about reducing the harm associated with
smoking.
Central Coast Area Health service also considered it crucial that the Area Heath
Service promote health to individuals, such as patients, and promote healthy
public policy to organisations. Just over 14% of the work places with more than
20 workers in NSW have a total ban on smoking, “even outside”13. On the
Central Coast, Masterfoods and Sanitarium are examples of companies with
large indoor and outdoor areas, all of which are totally smoke free. It was
considered vital that large high profile organisations such as the Area Health
Service support and reinforce this trend in healthy public policy.
Process
Central Coast Area Health Service utilised the following timeframe for
introducing a smoke free workplace policy.
Table of Implementation Phases
Phase One Development of a Health Service Implementation Early 1996

Strategy and commence education and promotion
Phase Two Introduction of smoke free campuses with Sept 1996

exemptions for nominated outdoor areas
Phase Three Review of exemptions and preparation for smoke free Informal, ongoing
public care facilities and campuses monitoring
Phase Four Totally smoke free health care facilities and Sept 2000
campuses under the control of Central Coast Area
Health Service

25
An Implementation Group has been established in preparation for Phase 4 which
includes representatives from human resources, maintenance, the Board, site
managers, health promotion, community health, Area Executive. The group is
responsible for signage, incorporation of smoke free requirements into other
policies, contracts and leases, media campaigns and information strategies,
training for middle management.
The group will also hold meetings for consultation with representatives from other
groups such as unions, or units which request it.
Surveys and focus groups have been undertaken in support of the

implementation process. The research identified existing practices and
problems at individual campuses and identified attitudes and potential barriers
to implementation of the policy.
Barriers / Problems Encountered & Solutions

Barriers/ problems Solutions
encountered
Potential reluctance of middle • targeted training for middle management
management to enforce • enlisting support from Board, general community,
restrictions with staff – local 'health' community, unions
especially in relation to • provision of support for staff who smoke
designated areas and
specified break times
Resistance from staff • recognition that staff may not want to (and do not
have to) stop smoking
• provision of 1 month supply of NRT to staff who
smoke if they wish to use it for maintenance or
quitting (see details below)
• supporting policy that staff will not facilitate
smoking for non-ambulatory patients (with the
exemption for palliative care patients in specified
circumstances)
Resources/ Communication Strategies
Central Coast Area Health Service utilised the following in support of the
implementation of the policy:
• "Tackling Tobacco" magazine
• Messages to staff on pay slips
• TV, radio and local media campaigns
• Kit for patients and staff including QUIT Kit, information about NRT, leaflets
(eg ' How to Help a Hospitalised Smoker')

26
Worth A Mention
Central Coast Area Health Service recognises the effects of long term addiction
to nicotine and the role of NRT in both management of nicotine addiction and in
cessation. New advances in the approach to the use of NRT suggest that
patches can be used in combination with smoking in order to decrease the
number of cigarettes consumed. Full compliance with NRT is ideal but not
essential as any decrease in the amount of smoking can provide health benefits.
Use of NRT whilst at work is seen as a way to assist staff – by decreasing

withdrawal symptoms and reducing the number of cigarettes consumed. Staff
can still smoke during their breaks if they choose. The Central Coast Area
Health Service NRT program offers 1 month supply of NRT to staff who smoke,
funded by the Health Promotion Unit at an average of $80 per person. Nicabate
was chosen as it provides telephone support.
Staff who use the program are given a kit which contains a QUIT Kit, a letter with
details of their NRT which they can take to their doctor or pharmacist if they wish
to continue the NRT, a letter about potential follow up contact after 6 months,
information to contact Nicabate if they experience any side effects from the NRT.
Inpatients are entitled to NRT if it is prescribed by their treating doctor. To

ensure consistency and to support the patient's right to make an informed choice
about NRT, Central Coast Area Health Service recommends that NRT
requirements be considered as part of the normal admission process, and that
information also be given about the benefits of quitting or reducing consumption.
More Information
If you would like further information about the Smoke Free Workplace Policy in
Central Coast Area Health Service, please contact:
Name: Douglas Tutt

Position: Director
Unit: Health Promotion Unit
Organisation: Central Coast Health
Phone: 02 4349 4800
Address: PO Box 361
Gosford NSW 2250
Email: dtutt@doh.health.nsw.gov.au

27
SOUTH EASTERN SYDNEY AREA HEALTH SERVICE
Rationale
South Eastern Sydney Area Health Service replicates the rationale provided in
the NSW Health Smoke Free Workplace Policy, namely:
• reduce the harm associated with tobacco use among staff, patients and
visitors, including exposure to environmental tobacco smoke;
• provide a clear and consistent message to everyone about the hazards of
smoking, and that smoking causes disease and death;
• indicate that smoking cessation is a positive commitment to good health; and
• provide leadership in the community about reducing the harm associated with
smoking.
South Eastern Sydney Area Health Services policy also ensures that the Area
Health Service meets its obligations under Occupational Health & Safety
legislation by providing a workplace free from the hazard of tobacco smoke. It
also recognises the importance of the Area Health Service as a role model for
the control of passive smoking in the community
Process
South Eastern Sydney Area Health Service have outlined a four stage process in
the implementation of their Smoke Free Workplace policy, described as follows:
1. The implementation of the policy will be in a staged approach over a period
of three years and will involve four phases. The first phase will involve the
development of the Area SFWP strategy by means of an Area
Implementation Committee and an extensive promotion and publicity strategy
concerning the changes. This phase is due to be completed by 31 August
1999.
2. The second phase will target staff only in the introduction of smoke free
campuses and will commence from 1 September 1999. Smoking on-site for
staff will be allowed only in designated outdoor areas which are out of the
view of the public.
3. The third phase, commencing from 1 January 2000, extends the policy to
include patients and visitors.
4. Phase four, commencing from 1 January 2002, involves a review of
exemptions granted during phases two and three with the aim of determining
the barriers to all facilities becoming totally smoke free.

28
Phase One Development of a SEH Implementation To 31 August 1999

Strategy and commencement of education
and promotion.
Phase Two Promotion of the image of a non-smoking From 1 September 1999

healthcare workforce.
Targeting staff with the introduction of smoke

free campuses with designated staff smoking
areas which are out of the view of the public.
Phase Three Extending smoke free campuses to include From 1 January 2000
patients and visitors.
Phase Four Review of exemptions and preparation for From 1 January 2002
smoke free public health care facilities and
campuses.
The development of the South Eastern Sydney Area Health Service policy and
implementation plan was overseen and coordinated by the South East Health
Implementation Committee for the Smoke Free Workplace Policy.
The Implementation Committee includes the CEO of the Area Health Service
and representatives from health services, Area services, associations and the
Cancer Control Program. The role of the Area Implementation Committee is to:
• develop and oversee the Area implementation strategy;
• manage the consultative process at the Area level;
• ensure consistent application of the policy across the Area;
• evaluate each phase of implementation;
• ensure that Occupational Health and Safety obligations are met.
The South East Health Smoke Free Workplace Policy was endorsed by the
Area Health Board on 6 September 1999.

29
Barriers /Problems Encountered & Solutions

encountered
Potential for staff who smoke to • Survey of smokers to identify interest in
feel harassed quitting, what methods previously tried.
Survey also provides forum for expression
of feelings and concerns
• Consistent sympathetic message conveyed
to smokers
• Exploring options for NRT for staff who
smoke including pilot program of rebate on
NRT (see details below)
Large area with many facilities. • Recognise effectiveness of building
Potential for differences in networks and links
management structures, • Support and advocacy from senior
priorities, levels of commitment, management
approach to implementation • Support from introduction of NSW Health
policy
• Maintain information flow
• High level of commitment from staff who are
coordinating and driving the process
Lack of funding resources eg • Information in Area newsletter
for promotional material, • Survey adapted for staff who smoke only
surveys, support for smokers • Some implementation subsumed into
facility redevelopment processes
South Eastern Sydney Area Health Service utilised the following in support of
implementation of the smoke free policy:
• a brochure for staff (based on the Western Sydney Area Health Service
brochure);
• regular updates and stories in the newsletter "The South Easterly";
• low key implementation rather than high profile launch.
Worth A Mention
Several options for Nicotine Replacement Therapy (NRT) programs for staff
have been considered by South Eastern Sydney Area Health Service. There is
currently a pilot program at St Vincent's Hospital which provides a one-off
voucher to staff who want to use NRT. The voucher can be redeemed for a $20
rebate after purchase of NRT, administered through the hospital petty cash
system and funded by Health Promotion. Limited funding restricts the program
to a total of 200 vouchers.

30
More Information
South Eastern Sydney Area Health Service, please contact:
Name: Geraldine Leslie

Position: Director
Unit: Human Resources
Organisation: South Eastern Sydney Area Health Service
Phone: 9382 9834
Address: PO Box 430
Kogarah NSW 1485
Email: leslieG@doh.health.nsw.gov.au
Name: Jo Morrissey
Position: Coordinator, Smoke Free Workplace Policy
Unit: Safety & Injury Management Centre
Organisation: South Eastern Sydney Area Health Service
Phone: 9382 8161
Address: Royal South Sydney Complex
Joynton Ave
Zetland NSW 2017
Email: morriseyj@sesahs.nsw.gov.au

31
WESTERN SYDNEY AREA HEALTH SERVICE
Rationale
Western Sydney Area Health Service is committed to:
• Reducing the harm associated with tobacco use among staff, contractors,
patients/clients and the community
• Providing a clear and consistent message to staff, contractors,
patients/clients and the community about the hazards of smoking
• Providing a clear and consistent message to staff, contractors,
patients/clients and the community that smoking is not a healthy activity and
• Providing leadership in the community about reducing the harm associated
with smoking
Process
An Area committee, auspiced by the Area Executive Forum, has been set up to
oversee the implementation of the policy. The committee consists of
representatives from the units, corporate services, public affairs, the trade
unions, community health, patient/client representative, drug and alcohol
services, human resources and health promotion.
The Western Sydney Area Health Service implementation plan recommends that
locality committees also be set up with broad membership base open to
management, staff, union, patient and community representatives and including
smokers and non-smokers. Local Committees will prepare a status report at the
end of each phase to inform the Area Committee on implementation to date and
any outstanding issues.
The implementation of this policy will involve four phases which are outlined
below.
Phase One Establishing Implementation plan and 1 September 1999 to 30

mechanisms; preparation of information March 2000
strategies & promotional material
Phase Two Temporary designated smoking areas; 1 April 2000 to 1 October 1
exemptions for patients/clients to be decided 2000
according to specified criteria
Phase Three Review of exemptions; review of information & 2 October 2000 to 31
promotion required in support of phase four December 2000
Phase Four Totally smoke free campuses; limited 1 January 2000
exemptions may be retained

32
The first phase aims to ensure the effective implementation of the policy. For
this to be successful there should be a mechanism for developing a local
implementation plan with identification of local issues and a consultative process
tailored to local needs. There will also be a promotional and publicity campaign.
• Each locality should set up a committee to develop an implementation

strategy specific to its needs. The committee should be a representative
group including local trade union delegates and smokers. Care should be
taken to ensure that the focus of the promotion should be on the benefits of a
smoke-free environment and not as a campaign against smokers.
• The Area committee will develop extensive promotion and publicity
concerning the changes about to take place.
• Applicants joining the organisation from this date will receive an information
package regarding the changes that are taking place.
• Clients and the community entering the campuses of Western Sydney Area
Health Service will receive a flyer advising them of the changes.
• The Area committee will provide training for managers and supervisors to
enable them to implement the policy with their workforce.
• The Area committee will provide information on staff pay slips advising them
of the changes taking place across the Area Health Service.
• The Area committee will make Quit kits available for those people who
choose to try to quit.
• Local committees will maintain regular contact with the Area committee.
• Status reports will be provided one month prior to the completion date of each
phase.
During phase two staff and clients will be allowed to smoke in temporarily
designated areas that have been agreed upon by Unit Executives. These
“designated “ areas will only be permitted to be used for smoking during this
phase. Unit Executives may apply for exemptions for patients/clients within the
specified exemption criteria.
• The Area committee will develop and disseminate guidelines for Units and
Community Health to use where smoking is allowed for staff and for
patients/clients during this phase.
• There should be separate temporarily designated smoking areas for
staff/contractors and patients/clients/visitors.
• These areas should not be visible to each other.
• The separate temporary designated smoking areas should not be visible to
the public.
• The Area committee will develop and disseminate guidelines for exemptions,
which will be used for patients/clients only in special circumstance such as
residential or palliative care.
• The Area committee will disseminate guidelines to Managers and
Supervisors for staff members who wish to continue to smoke.

33
Phase three is a very short phase where exempted areas will be reviewed prior
to the date of all campuses in the WSAHS being smoke free
• The Area committee will provide information regarding the final phase of the
implementation plan on all pay slips in October 2000
• The Area committee will reinforce availability of quit kits
• Exempted areas for patients/clients will be reviewed by the Area committee
which will make final recommendations to the Area Executive Forum
• All locality implementation committees will prepare a status report for the Area
committee on unresolved local issues by 1 November 2000
At phase four Western Sydney Area Health Service will be smoke free. All
hospital and community health campuses as well as buildings and vehicles will
be smoke free. The exemptions that have been approved the Area Executive
Forum will be the only areas where smoking by patients/clients will be permitted.
Barriers /Problems Encountered & Solutions

encountered
Concerns about staff having to • Information and education provided about
leave more secure areas in risks, recognition of personal choice to
order to smoke smoke/ take the risk
Visitors who may not be • Still under consideration.
aware of the policy in spite of
signage - eg in Emergency
Departments in crisis
situations
Resistance/ concerns of staff • non confrontational approach to
who smoke implementation and communication
strategies - promotion of positive health
rather than 'anti-smoker' rationale
Western Sydney Area Health Service utilised the following in support of the
implementation of the policy:
• promotion of non-smoking as an essential component to good health
• positive public health image and fresh air for all
• recognition that smokers may not want to quit
• inclusion of smoke free policy information in recruitment and induction
information
• attachments to staff pay slips
• newsletters and bulletins for staff prepared and distributed by local
committees

34
• local media
• posters and flyers for staff and patients provided by Area Committee
• leaflet ' Your Health is Our Primary Concern: Important information for
smokers' (adapted from Westmead Hospital Drug & Alcohol Service leaflet,
April 1998)
• competition for suggestions for smoke free workplace logo - advertised via
flyer with pay slips
• lasercast information bulletins and videos
• signage provided by Area Committee, placement decided by local committee
More Information
Western Sydney Area Health Service, please contact:
Name: Nerilyn Lee
Position: Manager
Unit: Tobacco Program
Organisation: Western Sydney Area Health Promotion
Phone: 02 9840 3708
Address: PO Box 7118
Parramatta BC NSW 2150
Email: nerilynl@phu.wsahs.nsw.gov.au

35
SECTION FIVE:
"SHELL" IMPLEMENTATION RESOURCES
Media Release - draft
xxx date xxx
NSW Health a World’s First with new Smoke Free Workplace Policy
A world’s first, the NSW Health Department today initiated the new Smoke Free
Workplace Policy which aims to ban smoking in all NSW Health buildings,
vehicles and campuses.
‘NSW Health in facilitating better health, aims to provide a smoke free

environment for our staff and patients,’ said XXX, XXX of XXXX.
‘There is overwhelming evidence that passive smoking is harmful. Long term

effects of passive smoking for adults include lung cancer, pneumonia and
increased risk of lung damage.
‘For children, there’s increased respiratory illnesses such as bronchitis,

pneumonia, slower lung growth, poorer lung function and coronary heart disease.
‘For two decades, we have seen the dangers of passive smoking, indicating the
negative health impact on non smokers.’
This initiative will begin with education and promotion of the Smoke Free
Workplace Policy for a period of 6 months. By September 2000, specified
outdoor smoking areas will be provided for staff, patients and visitors.
A 12 month consultation review will begin in September 2001 to ascertain

acceptance and success of this new policy. If the policy is approved, smoking
on any NSW Health property will be prohibited by September 2002.
‘We look forward to being world leaders in the promotion of good health, and
are pleased to have NSW Health staff and facilities provide a smoke-free
environment for our patients,’ said XXX.
-ends-
Media contact:

37
Brochure - staff
NSW Health Department Smoke Free Workplace Policy
The goal of the new Smoke Free Workplace Policy is to work towards totally
smoke free health care facilities and campuses by 1 September 2002.
The Smoke Free Workplace Policy will be phased in gradually so everyone has
time to prepare for its introduction. A 12 month review phase of the policy will be
undertaken prior to implementation in 2002.
Why is being a smoke free workplace important?

Smoking is recognised as the single largest preventable cause of death and
disease in Australia. We are all affected when exposed to tobacco smoke.
Medical evidence has confirmed that tobacco smoking and passive smoking are
harmful to health and a cause of heart disease, stroke, several forms of cancer,
bronchitis and can worsen the effects of asthma.
This policy shows your Health Service is committed to protecting the health of
staff, patients and visitors by reducing their exposure to tobacco smoke.
How are we protecting the health of our community?

The new Smoke Free Workplace Policy will:
• ensure all staff, patients and visitors are protected from tobacco related harm;
• ensure your Health Service continues to meet its obligations to staff, patients
and visitors under the Occupational Health and Safety Act 1983;
• provide community leadership in reducing tobacco related harm;
• meet changing community attitudes to tobacco smoking that recognises
smoking as an unhealthy activity.
What are the policy changes?

Currently, smoking is not allowed inside any Health Service vehicle or building.
There have to date, however, been no restrictions on smoking outdoors on health
service premises or campuses.
• As of 1 September 2000, smoking will only be allowed in nominated outdoor

areas.
• As of 1 September 2002, it is anticipated that all public health care facilities

and campuses will be totally smoke free.

38
• As a staff member, you may only smoke during designated breaks in outdoor
areas, which are nominated by your Health Service or Campus.
• If you are a patient or visitor, you may only smoke in an outdoor area, which
has been nominated by your Health Service or Facility.
Who is responsible for implementing the policy?

Each Area Health Service is responsible for the policy’s implementation. The
introduction of the policy will be gradual, with the aim of achieving a totally smoke
free environment by 1 September 2002. However, Health Services are
encouraged to achieve this goal earlier.
How was the Smoke Free Workplace Policy developed?

Discussions with key community groups and stakeholders highlighted community
concerns and the necessity for Health Services and campuses to take a leading
role in providing a smoke free environment.
The 1999 Smoke Free Workplace Policy was developed through a process of
review of policies and collaboration with health unions, NSW WorkCover and
Health Services.
Where can I get more information?

For more information or a copy of the NSW Health 1999 Smoke Free Workplace
Policy, contact your local Health Service or the NSW Health Department.

39
Brochure - patients and visitors
A Smoke Free Environment From Your Health Service
NSW Health will be introducing a revised Smoke Free Workplace Policy on 1

March 2000, with the goal of providing totally smoke free health care facilities
and campuses by 1 September 2002.
Why is providing a smoke free environment important?

Smoking is recognised as the single largest preventable cause of death and
disease in Australia. We are all affected when exposed to tobacco smoke.
Medical evidence has confirmed that tobacco smoking and passive smoking are
harmful to your health and a cause of heart disease, stroke, several forms of
cancer, bronchitis and can worsen the effects of asthma.
By removing tobacco smoke from the air, nicotine levels in the blood diminish,
and carbon monoxide levels return to normal. Also, blood oxygen levels increase
which means quicker recovery from illness, injury or surgery.
Implementing this policy shows your Health Service is committed to protecting

your health.
How are we protecting the health of our community?

The new Smoke Free Workplace Policy will:
• ensure all staff, patients and visitors are protected from tobacco related harm;
• ensure your Health Service continues to meet its obligations to staff, patients
and visitors under the Occupational Health and Safety Act 1983;
• provide community leadership in reducing tobacco related harm;
• meet changing community attitudes to tobacco smoking that recognises
smoking as an unhealthy activity.
What does this policy mean?

Currently, smoking is not allowed inside any Health Service vehicle or building.
There have to date, however, been no restrictions on smoking outdoors on health
service premises or campuses.
The Smoke Free Workplace Policy will be introduced gradually so everyone has
time to prepare for its introduction. It is anticipated that its full implementation will
occur in 2002.
• As of 1 September 2000, smoking will only be allowed in nominated outdoor

areas.

40
• As of 1 September 2002, it is expected that all public health care facilities and
campuses will be totally smoke free.
How was the Smoke Free Workplace Policy developed?

Discussions with key community groups and stakeholders highlighted community
concerns and the necessity for Health Services and campuses to take a leading
role in providing a smoke free environment.
The 1999 Smoke Free Workplace Policy was developed through a process of
review of policies and collaboration with health unions, NSW WorkCover and
Health Services.
For more information or a copy of the NSW Health 1999 Smoke Free Workplace
Policy, contact your local Health Service or the NSW Health Department.
How do I quit smoking?

There are many reasons why going totally smoke-free is the best choice. For
more information and assistance, there are many excellent resources currently
available to assist you if you decide to quit smoking. Contact your Health
Service or the Quitline on 131 848 for 24 hour advice and tips on quitting or to
get a copy of the Quit Kit.

41
Notice for Staff and Patient Bulletin Boards
Extension of Smoke Free Areas

To ensure the NSW Health Service meets its obligations under Occupational Health and Safety
legislation, and to show leadership in the promotion of better health, a new Smoke Free
Workplace Policy, formed with Health Services, Unions and WorkCover, has been introduced.
The Smoke Free Workplace Policy, based on the 1988 policy that prohibits smoking inside
buildings or vehicles, will be introduced as follows.
Stage 1 - 1st March 2000

Education and promotion of the change in policy.
Stage 2 - 1st September 2000

Smoking will only be permitted in designated outdoor areas that are a substantial distance away
from:
• ventilation shafts
• entrances/doorways
• food preparation areas
• hazardous substances and equipment.

A 12 month review of the policy will be undertaken. Pending the outcome of the review,
preparations will begin for completely smoke free public health facilities and campuses.

Pending Stage 3, smoking will not be permitted anywhere in Health Service buildings, vehicles
or campuses by any person.
Exemptions
NSW Health is committed to implementing a policy where smoking is prohibited on any
property controlled by NSW Health and Health Services. However, it is recognised the flexible
application of the policy may be required for patients, visitors and staff. As such, applications
for outdoor areas where smoking may be allowed in specific circumstances will be considered.
For more information, contact:

Health Promotion
Occupational Health and Safety Representative
Risk Manager
Unions

42
Sample Letter for Employees
Dear Colleague
RE: Introduction of the revised NSW Health Department’s Smoke Free

Workplace Policy
As you may be aware, a new Smoke Free Workplace Policy has been
introduced by NSW Health. This policy has been developed in collaboration with
Health Services, Unions and WorkCover. The 1999 Smoke Free Workplace
Policy will ensure that NSW Health meets its obligations under Occupational
Health & Safety legislation, and exhibits its leadership role in the promotion of
better health.
It is recognised that there are a diverse range of facilities and campuses which
exist throughout the NSW Health system. Therefore, each campus will need to
recognise their unique circumstances in applying the Smoke Free Workplace
Policy. As such, exemptions for nominated outdoor areas may need to be
granted to address the particular needs of specific patient groups and staff.
To ensure successful implementation, the policy will be phased in over a period

of two and a half years to ensure that staff, patients and visitors have adequate
time to adjust to the changes in the policy. The following outlines the relevant
dates and restrictions.
1 March 2000
1 September 2000
Smoking will only be permitted in designated outdoor smoking areas that are a
substantial distance away from:
• ventilation shafts
• entrances/doorways
• food preparation areas
• hazardous substances and equipment.
1 September 2001
A 12 month review of the policy will be undertaken. Pending the outcome of the
review, preparations will begin for completely smoke free public health facilities
and campuses.
1 September 2002
Pending the review, smoking will not be permitted anywhere in health service
buildings, vehicles or campuses by any person.

43
It is envisaged that Working Groups will be established which include staff and
union representation for the implementation of this policy within individual
campuses. I encourage you to contact your manager should you wish to
participate in these Working Groups or to find out more information regarding
the Policy.
To assist staff who wish to quit smoking, your Health Service offers a range of
cessation services. Attached to this letter is a list of services available within the
XYZ Area or phone the Quitline on 131 848 for 24 hour tips and advice on
smoking cessation, or to obtain a Quit Kit.
I trust that you will join me in supporting the implementation of this policy. I would
like to take this opportunity to thank you for your contribution in ensuring a healthy
workplace in XYZ Health Service.
Yours sincerely
Chief Executive Officer

44
Editorial for Patient and Client Newsletters and Public
Information Brochures
New Smoke Free Workplace Policy
The 1999 Smoke Free Workplace Policy by NSW Health was introduced with
the goal to have all indoor and outdoor areas of NSW Health buildings and
campuses smoke free.
Smoking is recognised as the single largest preventable cause of death in

Australia, killing around 18,000 Australians each year. These deaths impact
heavily on thousands of families and friends. The Smoke Free Workplace Policy
will ensure that all Occupational Health and Safety obligations are met and
enable NSW Health to be a leader in the promotion of better health.
The Smoke Free Workplace Policy will be implemented over the following
phases:
1 March 2000
1 September 2000
Smoking will only be permitted in designated outdoor smoking areas.
1 September 2001
A 12 month review of the policy will be undertaken. Pending the outcome of the
review, preparations will begin for completely smoke free public health facilities
and campuses.
1 September 2002
Pending the review, smoking will not be permitted anywhere in health service
buildings, vehicles or campuses by any person.
The 1999 Smoke Free Workplace Policy has been developed to reduce harms
associated with passive smoking amongst NSW Health staff, patients and
visitors. Research over the past two decades in the area of passive smoking
indicates a significant effect on the non-smokers’ health and poses a particular
danger to the respiratory health of young children.
Research has identified the following short term effects of passive smoking:
• eye irritation
• coughing
• headaches
• reduced lung function in asthmatic non smokers
• reduced attentiveness
• reduced problem solving ability and increased agitation.

45
The long term effects include:
• lung cancer
• pneumonia
• increased risk of lung damage in adult non smokers
• increased serious respiratory illnesses such as bronchitis and pneumonia in
children whose parents are smokers
• slower lung growth and poorer lung function in young children whose parents
smoke
• coronary heart disease.
Many patients take the opportunity to quit smoking whilst undergoing treatment at
Health Service facilities. There are many benefits to stopping smoking such as
the nicotine levels diminish, carbon monoxide levels in the blood returns to
normal, and oxygen levels in the blood start increasing. This means a quicker
recovery from illness, injury or surgery.
Contact your Doctor or other Health Professional to discuss any assistance that
you may require in ceasing smoking. The Health Service also has a range of
services which may be of assistance:
(List…….)

46
Signage
LOGO
XYZ Area Health Service promotes healthy lifestyles

and supports a smoke free workplace and
environments.
In the interests of better health, smoking is not

permitted on this campus.

47
SECTION SIX: REFERENCES
1
US Department of Health and Human Services. Reducing the health
consequence of smoking: 25 years of progress. A report of the Surgeon
General, Rockville, Maryland: US Department of Health and Human Services,
Public Health Service, Centres for Disease Control, Centre for Chronic
Disease Prevention and Health Promotion, Office on Smoking and Health,
1989. DHHS Publication No (CDC) 89-8411.
2
ABS. Causes of death. Australia. 1993 ABS Catalogue 3303, Canberra
1994.
3
Winstanly M, Woodward S, and Walker N, Tobacco In Australia: Facts and
Issues. Second Edition. Published by the Victorian Smoking and Health
Program, Australia (Quit Victoria), 1995
4
WorkCover NSW, 1997, Passive Smoking in the Workplace, WorkCover
NSW.
5
Cancer Council, 1997, When Smoke Gets in Your Eyes. NSW Cancer
Council
6
National Heart Foundation Survey, 1994.
7
Mortner P, Bennett G, Green S 1996. Smoking Policy and Cessation in an
Inner City Hospital, Journal of the National Medical Association. Jan 88(1) 43-
47; New Mexico, USA
8
Ashley M, Bull J and Pederson L 1995, Support Among Smokers and Non
Smokers for Restricutions on Smoking, American Journal of
Preventative Medicine, Sep - Oct (5) 283-287. Canada
9
NSW Health Department. NSW Tobacco and Health Strategy 1995 -
1999. NSW Health Department
10
Irving L, Seidner, Burling T, Thomas R and Brenner G, 1994, Drug and
Alcohol Abuse Inpatients’ Attitudes and Smoking Cessation. Journal of
Substance Abuse, 6 (3) 267 - 278. England
11
12
13
NSW Health Survey 1997, Workplace smoking restrictions. Internal Health
Document wysiwyg://7/http://internal.health.nsw.gov.au/public-
health/hs97/smk_sm3.htm

48

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NSW Department of Health