ASEAN Smoke-free Award

Nomination Form

Information of Nominee:

Name of City/Municipality/Province/State/Region/District:

PADANG PANJANG
_______________________________________________________________________________

Name of Mayor/Governor/Chief Minister:

FADLY AMRAN, BBA

_________________________________________________________________________________

RAHMAISA, SKM
Informant: _______________________________________________________________________

Position/Designation:

Head of Public Health, Prevention and Disease Control

_______________________________________________________________
Health Office, Padang panjang city
Name of Office: ____________________________________________________________________

Email: ___________________________________ Mobile No.: ______________________________

Eligible Applicants: Cities from ASEAN Member States are eligible for the ASEAN Smoke-free Award
(ASA). In the context of ASA, ‘Cities’ shall be used as a collective word which includes provinces,
cities, municipalities, states, districts, and the like.

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 ASEAN Smoke-free Award

Smoke-free Rating System

Evaluation Form

Instructions: Please place an (X) in the applicable box for your answers.

1. SMOKE-FREE ENCLOSED PLACES AND PUBLIC PLACES (Policy)

a. Do you have a Smoke-Free Ordinance/Regulation/Law implemented?

YES X NO

If YES, what is the title of your Smoke-Free Ordinance/Regulation/Law?

REGIONAL REGULATION OF PADANG PANJANG CITY NUMBER 2 OF 2014

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

b. Please check the smoke-free places based on the law:

Bars/Pubs X Hotels X Workplaces/Offices

Airports X Restaurants X Transportation (Public)

X Universities X Healthcare Facilities Shops/Shopping Complexes

X Educational Facilities X Transport Terminals

Allows smoking rooms in some places

Please specify the places and the guidelines:

No
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

X Allows designated outdoor smoking area in some places.

Please specify the places and the guidelines:

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 Especially for workplaces, public places, and others places are provided designated smoking
area. Regional Regulation Of Padang Panjang City Number 2 Of 2014

Allows smoking anywhere outdoors.

Documentation needed:
1. Copy of Smoke-Free Ordinance/Regulation/Law being implemented
2. Directive approved by the head of the city for the strict implementation of the law
3. Additional places that are not in the national law that are added as smoke-free places
within the city (e.g., public outdoor places)

2. TASK FORCE OR WORKING GROUP (Enforcement)

Choose one answer among the options below.

X Has a Task Force or working group strongly enforcing the law; with regular meetings

NAME OF YOUR SMOKE-FREE TASK FORCE/WORKING GROUP:

__________________________________________________________________________

Documentation needed:
1. Organizational Chart of the Task Force with corresponding roles and responsibilities
2. Designated one focal person or an office to oversee or supervise the implementation of
the plan/activities
3. Photos of the Task Force in action or a group photo,
4. Schedule of meetings with minutes of meeting

Has a Task force but not enforcing

NAME OF YOUR SMOKE-FREE TASK FORCE/WORKING GROUP:

__________________________________________________________________________

Documentation needed:
1. Organizational Chart of the Task Force with corresponding roles and responsibilities
2. Designated one focal person or an office to oversee or supervise the implementation of
the plan/activities
3. Photos of the Task Force in action or a group photo
4. Schedule of meetings

Has no Task Force or working group

3. ORGANIZATIONS (Enforcement)
Choose one answer among the options below.

X Local government actively working with non-government organizations for smoke-free

Identify the NGOS with their corresponding contribution to the campaign. (Use

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 separate page)
______________________________________________________________________
______________________________________________________________________

Documentation needed:
1. Photos of NGOs in action
2. Copy of MOA or MOU, if applicable

Local government working with some NGOs but are not regularly involved
Identify the NGOS with their corresponding contribution to the campaign. (Use
separate page)
_______________________________________________________________________
_______________________________________________________________________

Documentation needed:
1. Photos of NGOs in action
2. Copy of MOA or MOU, if applicable

Not working with any organization

4. POLITICAL WILL (Policy & Enforcement)

Choose one answer among the options below.

Mayor of city and other political leaders are actively supporting

X
the smoke free campaign

Documentation needed:
1. Documented support from the head of the city or district through policies, funding,
moral support etc.
2. Photos with Head of the city in action including key messages or statements
(Use separate page)

Mayor of city/municipality/province may be supportive but also entertains the tobacco

industry or prioritizes conventional cigarettes or e-cigarettes sales

Documentation needed:

1. Documented support from the head of the city or district through policies, funding,
moral support etc.
2. Photos with Head of the city in action including key messages or statements
(Use separate page)

Not supportive

5. STRATEGIES (Enforcement)

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 Choose one answer among the options below.

City has initiatives and activities to promote smoke-free and has achieved its goal.

Documentation needed:
1. Plan of action on smoke-free/tobacco control
2. Schedule of activities
3. List of activities done
4. Photos of activities.

X City has started or initiated some activities to promote smoke-

free but not sustained or did not achieve its goal.

Documentation needed:
1. Plan of action on smoke-free/tobacco control
2. Schedule of activities
3. List of activities done
4. Photos of activities.

No activities

6. MONITORING/MASS MEDIA (Policy & Enforcement)

Choose one answer among the options below.

X City has the strong support from the media (tv, radio, newspaper) and frequently
publish articles or news on smoke-free.

Documentation needed:
1. List of establishments inspected/ Total number of establishments (hotels, restaurants,
workplaces etc.)
2. Monitoring report (includes recommendations)
3. News and video clippings (Attach copies or share the links to the news articles. Use
separate page)

City has some support from the media but sometimes the city has to pay for the
publication of news articles on smoke-free.

Documentation needed:
1. List of establishments inspected/ Total number of establishments (hotels, restaurants,
workplaces etc.)
2. Monitoring report (includes recommendations)
3. News and video clippings (Attach copies or share the links to the news articles. Use
separate page)

No media support

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7. OUTDOOR ADVERTISEMENTS (Enforcement)
Choose one answer among the options below.

X Remove visible advertisements of tobacco products and replace them with tobacco
control messages

Documentation needed:
1. No visible tobacco advertisements and materials with names of logos of the tobacco
products e.g. parasols, ashtrays, tissue holder (based on actual inspection and
monitoring)
2. Visible No Smoking signs in enclosed places and public places
3. Smoke-free posters/billboards/Graphic Health Warning posters seen in public places
4. Photos of activities

With tobacco control messages in billboards/posters but still allows tobacco product
advertisements

Documentation needed:
1. No visible tobacco advertisements and materials with names of logos of the tobacco
products e.g. parasols, ashtrays, tissue holder (based on actual inspection and
monitoring)
2. Visible No Smoking signs in enclosed places and public places
3. Smoke-free posters/billboards/Graphic Health Warning posters seen in public places
4. Photos of activities

Tobacco advertisements allowed everywhere but may or may not have tobacco control
messages

8. KEY MESSAGES (Enforcement)

Choose one answer among the options below.

X With strong messages on smoke-free/tobacco control used during the smoke-free

Campaign

Documentation needed:
1. Smoke-free/tobacco control messages placed on posters or billboards located at
strategic areas of the city
2. Visible/large “This a Smoke-free City” sign or billboard posted at the boundary or
entrance of the city
3. Strong smoke-free declaration from the head of the city. (Statement or video)

With some messages but has no impact with the public

Documentation needed:

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 1. Smoke-free/tobacco control messages placed on posters or billboards located at
strategic areas of the city
2. Visible/large “This a Smoke-free City” sign or billboard posted at the boundary or
entrance of the city, if available
3. Smoke-free declaration from the head of the city. (documented)

No strong messages

9. IMPLEMENTATION/INSPECTION (Enforcement)
Choose one answer among the options below.

Enforcers regularly enforcing the law.

Documentation needed:
1. Identify the members of the enforcement team including their roles and responsibilities.
2. Photos of enforcers in action
3. What is the protocol for apprehending violators? (Use separate page)
4. Inspect at least 10 establishments (hotels, restaurants, coffee shops etc) using the
inspection form

Penalties and fines for violations:

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

X Enforcers may be enforcing but not done regularly

Documentation needed:
1. Identify the members of the enforcement team including their roles and responsibilities.
2. Photos of enforcers in action
3. What is the protocol for apprehending violators? (Use separate page)
4. Inspect at least 10 establishments (hotels, restaurants, coffee shops etc.) using the
inspection form

Penalties and fines for violations:

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Not enforced

10. NEVER NEGOTIATE WITH THE TOBACCO INDUSTRY (Policy & Enforcement)
Choose one answer among the options below.

X With policy/instructions or follows a national policy not to negotiate with the tobacco

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 industry and strongly enforced

Documentation needed:
1. Identify the policy and attach a copy.
2. No report of tobacco industry interference
3. Directive from the head of the city on No Interference from the TI

With policy/instructions or follows a national policy not to negotiate with the tobacco
industry but still entertains/works with the tobacco industry

Documentation needed:
1. Identify the policy and attach a copy.
2. No report of tobacco industry interference
3. Directive from the head of the city on No Interference from the TI

No policy

11. GOVERNMENT SUPPORT (Policy & Enforcement)

Choose one answer among the options below.

X With full support from the government

Documentation needed:
1. All government offices are 100% smoke-free. Inspect 10 government offices and check
smoke-free compliance. Use the inspection form.
2. With regular budget to support the enforcement of the smoke-free law
3. No opposition from government officials on the strong enforcement of the smoke-free law

May have some support from government but not sustained

Documentation needed:
1. All government offices are 100% smoke-free. Inspect 10 government offices and check
smoke-free compliance. Use the inspection form.
2. With regular budget to support the enforcement of the smoke-free law
3. No opposition from government officials on the strong enforcement of the smoke-free law

No support

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Prepared by the Southeast Asia Tobacco Control Alliance (SEATCA) for the ASEAN Smoke-free Award. First published
in the Smoke-free Toolkit: Implementing FCTC Article 8 Guidelines (Protection from Exposure to Tobacco Smoke, 2016.
https://seatca.org/dmdocuments/SMF%20Toolkits%202016.pdf