EMPLOYEE SATISFACTION SURVEY
Please check the appropriate response to each item. Thank you.
Date
1. Have you ever completed a safety culture survey?
Yes
No
2. Have you seen the results of a safety culture survey?
Yes
No
3. Does your supervisor discuss the results?
Yes
No
4. Would you feel comfortable reporting intimidating behavior?
Yes
No
5. When an error occurs, do you have confidence that your leadership will take an appropriate look at how the system or process is accountable versus an individual?
Yes
No
6. Does the organization have a process in place for reporting "close calls/near misses" or an error occurred but did not reach the patient?
Yes
No
7. I have adequate opportunities for professional growth in this organization.
Yes
No
8. I am encouraged to learn from my mistakes.
Yes
No
9. We constantly look for ways to improve our services.
Yes
No
10. I can disagree with my supervisor without fear of getting in trouble.
Yes
No
11. I am encouraged to report any patient safety issues (e.g., falls, incidents, etc.) without retaliation.
Yes
No
12. Management listens to staff ideas and suggestions to improve patient and employee safety.
Yes
No
13. Senior management is genuinely interested in employee opinions and ideas.
Yes
No
14. My ideas and opinions count at work.
Yes
No
15. Communication is encouraged in this organization.
Yes
No
16. My workplace is safe.
Yes
No
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Employee Name: (OPTIONAL)
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