Get Tobacco Free Attestation

Filling out the Tobacco Free Attestation is an important step towards promoting a tobacco-free lifestyle. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete your Tobacco Free Attestation.

1. Press the ‘Get Form’ button to access the Tobacco Free Attestation document and open it in your preferred online editor.
2. Begin by entering your printed name in the designated area on the form.
3. Confirm your understanding of what constitutes tobacco use as described in the document, and certify your compliance with the tobacco-free policy.
4. If applicable, indicate that you have completed the Butt Stops Here tobacco cessation program and attach your original completion certificate to substantiate your claim.
5. Provide information regarding your department by filling out the relevant section.
6. Choose your designation, confirming whether you are tobacco-free or have completed the cessation program.
7. Acknowledge that you will notify Ellis Medicine of any changes in your tobacco use status in writing.
8. Review your information to ensure accuracy, then sign the document in the designated area to certify that you have provided truthful information.
9. Fill in the date of signing.
10. For additional wellness activities, document your participation in two different approved activities and describe how they contribute to your personal well-being.
11. Once you have completed the form, save your changes, and choose to download, print, or share the form as needed.

Complete your Tobacco Free Attestation online today to contribute towards a healthier environment.