Speaking up for Safety - Post Workshop Survey

This Survey is to be completed AFTER the workshop

Please rate the extent to which you agree with the following
statements AFTER attending this workshop.
Mark a cross in the box that most appropriately
represents your response to each statement.
1.Which Area/Department are you working in(Required.)
2.Your role in the organisation (e.g. grad nurse, medical officer, admin, consultant etc)
3.I am aware of the need to speak up
when I observe behaviours that may
compromise safety
4.I have a desire to speak up when I observe
behaviours that may compromise safety
5.I have the knowledge and skills to know
how to speak up for safety
6.I have the ability to turn my knowledge into
action and speak up whenever I observe
behaviours that may compromise safety
7.I am confident to speak up when I observe
behaviours that may compromise safety
8.I am confident to elevate my issue to an
appropriate person when I have not received
a satisfactory response after speaking up
about my safety concerns
9.In my work setting I welcome being checked
10.AFTER attending this workshop, I plan to always speak up when
I observe behaviours that may compromise safety
11.AFTER attending this workshop, I plan to use the Safety C.O.D.E.™
to assist me with speaking up when I observe behaviours that may
compromise safety
12.Is there additional information, support or other factors that need to be addressed at this health service to increase the likelihood of you always speaking up for safety?