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The following questions aim at assessing our safety climate and culture, by use of employee's perceptions of our safety values, processes, reward systems and leadership in 3 Parts. The first part will be closed questions asking for your perception and attitudes in regards to our safety culture. Part 2 will give you the opportunity to provide written feedback, if appropriate and the last part will be asking you for some demographic information used for statistical purpose only. It will take you about 20 minutes to complete all 3 parts. Please respond to all questions honestly and openly and refer to the definition at the beginning of the Survey page whenever needed. Please note that results are only saved once you have answered all mandatory items and pressed the submit button at the end of the survey.

Preview Survey

Here is a sample survey questionnaire for your preview. You can scroll down the survey form web pages to see the various sections of the survey questionnaire. If you have any questions regarding the survey content or proper application, please see contacts for contact information.

Please keep these definitions in mind while taking the survey:

  1. Company -- refers to your specific employer, Allegheny Hospital or Metro Aviation.
  2. Company operation - refers to you main work area (Flight Operations, Maintenance, Communication, Administration or Support)
  3. Senior Management or Senior Manager - refers to executives that are responsible at Hospital or Aviation Division or Corporate levels.
  4. Local Management or Local Manager -- refers to individuals who manage day-to-day operations (Chief flight nurses, Aviation or Maintenance managers).


SECTION I: Items (66 questions)
1I believe our Company has an effective process for reporting unsafe conditions.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
2Local management provides adequate procedures for preventing personal injury.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
3My Company has a successful process in place to identify any person who may pose a risk on the job due to unsafe behaviors.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
4My Company's safety investigation reports are communicated to all employees as a lesson learned.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
5Submission of a safety concern is acknowledged in a timely manner.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
6My Company managers encourage reporting any safety discrepancies.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
7I am comfortable reporting safety concerns without fear of local or senior management reprisal.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
8Anyone found to intentionally violate standards or safety rules is corrected.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
9Deliberate violations of standard operating procedures are rare in my department or work area.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
10Senior Management (Hospital or Aviation Corporate or Division Level) supports a climate that promotes safety.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
 
11Local management supports a climate that promotes safety.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
12Local managers in my Company operation encourage all employees to follow the rules.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
13I am comfortable admitting to my boss that I have made a mistake.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
14There is genuine commitment to safe work practices in my Company.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
15Nursing staff would not hesitate to speak up if they see something that may affect patient safety.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
16Working safely is an integral part of all operations in our organization.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
17My Company operation has an excellent reputation for high quality work.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
18All Company employees are held accountable for poor work performance.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
19Best practices are followed in my Company operation to ensure high quality work is performed.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
20My local manager recognizes workers for their high-quality performance.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
 
21Workers in my Company carefully assess hazards during daily work operations.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
22I can easily identify the person that is responsible for safety in my Company.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
23Our safety personnel are very influential in promoting safety.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
24I have had specific training on the high-risk elements of my job.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
25I am confident that I can complete all of the tasks assigned to me within a normal shift period.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
26Sometimes I am so tired at work that I am not sure I can stay alert.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
27I am concerned about safety, because the company is too focused on controlling costs.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
28All of our Company operations are adequately staffed.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
29A common complaint among nursing staff is that fatigue levels are much too high.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
30Pilot extended duty periods and workload conditions are satisfactory for avoiding fatigue that might put some flights at risk.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
 
31In my opinion all aircraft used in patient transportation are safe and appropriate for the flight environments now flown.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
32Safety decisions, about a flight or patient care, are made by the most qualified people, regardless of rank or hierarchy.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
33Local management has a clear picture of the risks involved in transporting patients --including routine transports and scene EMS transport.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
34Employees in my Company take the time to identify and assess risk to ensure patient safety.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
35There are adequate resources (budget, personnel, equipment) needed to ensure patient safety.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
36In spite of our good safety record, we have NOT become complacent regarding safety matters.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
37Our procedures for entering and exiting a helicopter are done in the safest manner possible.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
38Pilots are properly trained on the benefits and limitations of night vision goggles.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
39Pilots follow established night flight procedures when wearing night vision goggles.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
40At our Company good communications flow exists up and down the organization.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
 
41Local Managers have communicated the Company's safety goals to all workers at my Company operation.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
42There is a perceived lack of management commitment to safety in my Company operation.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
43Company management, at all levels, ensures that all employees are responsible and accountable for safety.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
44Employees willingly provide advice to each other concerning safety matters.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
45I believe that employee morale here in the company is very high.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
46I get all the information that I need to perform my job safely.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
47Our local managers do not hesitate to correct unsafe behavior.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
48Our local manager listens carefully to employees regardless of job title or level in the company.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
49Communication among workers, while performing their jobs, is very good.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
50Senior management can be trusted to keep their promises to employees.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
 
51Managers in my Company operation are actively involved in the company's safety program.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
52My local manager ensures that all employees are responsible and accountable for satisfactory job performance.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
53My Company sets the highest standards in the industry for recruiting and hiring of its employees.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
54All Flight Nurses are trained to meet high levels of job qualification standards.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
55A pass down between work shifts or crews is completed so that job requirements and safety issues are adequately covered.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
56The maintenance schedule for returning an aircraft to flight service is often unrealistically short.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
57All of our maintenance operations are adequately staffed.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
58Regular crew meetings are used to communicate issues and to correct any misunderstandings.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
59Maintenance management encourages us to work by the book.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
60All pilots qualifications are carefully monitored to ensure that each is qualified for a particular aircraft and flight.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
 
61All of our aircraft maintenance technicians are trained in accordance with certification standards.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
62Our training and flight standards program is functioning effectively to ensure that our pilots meet required qualifications.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
63I believe that there are very few instances of communication failure between dispatch and flight crews.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
64Pilots receive adequate orientation training on landing zones - geographic areas, and ATC rules.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
65Pilots and maintenance personnel work closely together to ensure that all maintenance operations have proper oversight with satisfactory inspections.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
66Pilots and medical crew support one another in the performance of their duties.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
 
SECTION II: Open Ended (8 questions)
1.In your view, what situation or specific hazards or other factors may lead to an accident?
2.In your view, what are the most important safety actions that the company can take to reduce the chances of an accident?
3.What additional training would help you perform your job more effectively?
4.Do you believe that Flight Nurses need to communicate more effectively with pilots about safety of flight issues? Please comment.
5.Do you believe that pilots are reluctant to give advice to Flight Nurses?
6.Do you have any further suggestions or comments about safety in your Company Operation?
7.Can you think of any way that we can improve this particular survey?
67.Answer this question only if you are a flight nurse. I would rate the Indiana Base at the same level as my home base -- YES or NO - and comment why.
 
SECTION III: Demographics (5 questions)
1.Select your primary geographic location or main base.
1 - BASED ON USER LOGIN
2.What Company Operation are you associated with?
3.What is your current job title:
4.Select your primary Company affiliation (employer) from the list below:
5.How long have you worked at the company?
 

© 2001 - 2021 Dr. Anthony Ciavarelli, Human Factors Associates, Inc. All rights reserved.
This survey form, and its contents, cannot be duplicated in any manner without written permission from Dr. Anthony Ciavarelli.

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