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Temporary Aide to Certified Nurse Aide Facility Survey
*
1.
Facility Name
(Required.)
*
2.
Facility State ID Number
(Format: X000000, e.g., N103103)
(Required.)
*
3.
Facility Address
(Required.)
*
4.
County
(Required.)
*
5.
Are you currently using Temporary Aides in your facility? These are staff members who completed the 8 hour Temporary Nurse Aide course online through ACHA/NCAL.
(Required.)
Yes
No
*
6.
If you are using Temporary Aides, how many are working in this facility?
(Required.)
7.
If you had an opportunity to allow Temporary Aides to work after March 31, would you be interested in more information about how to transition your temporary aides to full Certified Nurse Aides?
Yes
No
*
8.
Any comments or suggestions?
(Required.)
*
9.
Name of facility contact
(Required.)
*
10.
At what email address would you like to be contacted?
(Required.)
