How did you learn about the Smoke-free Zone Certificate* Newspapers Social media websites Through an institution that has obtained the Smoke-free Zone Certificate during the past years Other (specify) Specify Date of form submission Name of institution Institution’s trade name (if applicable) Institution’s phone number Detailed address of the institution’s main branch City\Town Governorate SelectAjlounAqabaBalqaKarakMafraqAmmanTafielaZarqaIrbidJerashMaanMadaba Working hours Official holidays (non-working days) Number of applying locations\branches 1more_than_branch submitted_branches_info Number of employees in applying branches من 5 الى 20 من 21 الى 100 اكثر من 100 Are the institution's services provided only to minors under 18 years of age? Yes No Type of institution Schools Universities and other educational institutions Restaurants and cafes Hospitals, health centers and clinics Sports and health clubs Companies, associations and others Number of students: Grades that the school cover Number of classrooms Males/females/mixed Which of the MOE governorates does your school belong to? Private schools Governmental schools directorate_of_education National ID number of school Working periods One shift only Two shifts with the same principal Two shifts with different principals Job title of liaison officer Name of contact (Liaison officer) Liaison officer’s email Liaison officer’s telephone number Liaison officer’s mobile number What are the reasons that prompted your institution to take the decision to ban smoking? (Maximum 100 words) When was the institution declared a smoke-free zone? When was the smoking ban implemented (completely banning smoking inside all the institution's buildings) What are the facilities in which the institution prohibits smoking? What are the facilities in which the institution allows smoking? Does the institution prohibit smoking in its cars and other passenger vehicles? Yes No The institution does not own any cars or passenger vehicles Does the institution prohibit smoking during off-premises activities and events? Yes No The institution does not hold any off-premises activities Has the institution officially declared itself as a smoke-free zone? (By using at least one of the following: banners inside the institution, employment ads, newspapers, policy documents, etc.) Yes (Please specify declaration method in details) No declaration_in_details Does the institution place no smoking signs, ashtrays, or cigarette butt receptacles (to dispose of cigarette butts before entering the premises) at its entrances? Yes No Do the non-smoking zones of the institutions contain ashtrays? Yes No Has the institution educated its employees on the harm of smoking and exposure to secondhand smoke? Yes (Please provide details) No awareness_details Did the institution assign the responsibility for monitoring of enforcement of the smoke-free policy to one of its employees? Yes (Please provide details) No job_title Did the institution train staff on enforcing the smoke-free policy? (e.g. train waiters on dealing with a customer who smokes on site, or train teachers on dealing with a parent who smokes inside school premises) Yes (Please provide details on the training) No Details How would you rate your institution’s level of commitment: (the extent of commitment displayed by the institution and individuals in applying the smoke-free policy) Less than 50% 50% to 85% Over 85% Did the institution set a mechanism for dealing with violations related to the smoking ban? (Describe the method in relation to the staff at the very least. Please provide us with any documents, if available, by clicking on the download button.) Yes ( Please provide details on dealing with violations ) No submitted_file rags_details Does the organization periodically review the success of the smoking ban and the compliance of staff and visitors? How often does this review take place? What are the review criteria and standards? (Please choose one answer and mark X inside the box) Yes (Please provide details) No reviews_detailes What are the most important lessons learned and what are the changes and development points that the institution will work on? Once certifies, does the institution commit (within the limits of its ability) to contribute and spread the smoke-free culture in Jordan? (Please provide a description of what the institution intends to do. Yes (Please provide details) No awards_detailes All information provided above is true, complete and accurate. Please be aware that any deficiency or error in the information may affect the ability of the King Hussein Cancer Foundation and Center to reach a final decision about the institution’s qualification. Note: Unannounced inspection visits will be made to institutions applying for Smoke-Free Zone Certificate. Therefore, the institution must cooperate with representatives of the King Hussein Cancer Foundation and Center during their visit. For inquiries, please contact us via the following number: 00962776741428, from Sunday to Thursday between 12:00 PM - 15:00 PM. * This information is required Submit
