Work Life Hawaii Header Image
Menu - Employers
Sample Poll
Which EAP deliverable is most important?
 
Mailing List
Join Our Mailing List
Getting a Quote Print E-mail

We would be happy to prepare a quote for covering your company with EAP services. So we can best prepare this, please complete the following information and we will prepare a quote and be in touch with you soon.

WorkLife Hawaii Quote Request Form

Your Name: *
Title:
Company:*
Mailing Address:
City:
Zip:
Email:*
State
Total number of employees you wish to cover:*
Company Website:
Fax:
The number of employees at worksite locations (e.g. 200 Honolulu, 20 North shore Oahu, 15 Kona, 12 Hilo, 32 Kahului, 5 Kauai):
Telephone:*
Industry or occupation type (e.g. construction, manufacturing)*
List any specific issues or concerns within your company or why you're interested in an EAP (e.g. thinking of downsizing, morale issues)
Do you have DOT-level, safety sensitive employees?
Does your company do drug testing?
Do you currently have an EAP policy?*
How did you hear about us?
(Optional) The name of your current EAP Provider:
Your satisfaction with or feedback about your current EAP coverage, including why you are considering changing providers
Which are the most important EAP deliverables for your company? (Select the top three)*
 Increasing Productivity
Decreasing Health Care Costs
Helping Company with Risk Management
Decreasing Absenteeism
Decreasing Turnover
Providing Trainings
Helping Company Respond to Trauma/Disasters
Helping Troubled Employees
Helping Employees' Family Members
Increasing Utilization of EAP
Providing Assistance to Managers/Supervisors
Delivering EAP services at the lowest cost possible
What is your timetable for making a decision?
To prepare you a quote with a contract ready for your review, we need the following information:
Name of who our primary contact person at your company would be (if someone other than you)
Their Title:
Their Address (if different from above):
Their Phone:
Their Email Address:
Name of who would be signing the contract:
Their Title:

* Required field