Nebraska Organ Recovery System
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1. Organ/Tissue Donation Hospital Feedback Form

In an effort to continually improve our service to donor families and hospitals, NORS would appreciate your feedback regarding the recent organ/tissue donation case at your facility. Please take a few moments to complete the survey below. If you have any comments or suggestions to share with NORS please write them in the space provided. This information will be kept confidential and can be submitted anonymously. Thank You.

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Please fill in the information below: Hospital Name:
Hospital Unit:
Donor Initials:
Date of Donation:
Your Name (Optional):

Nebraska Organ Recovery System
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1. Organ/Tissue Donation Hospital Feedback Form

1. Please fill in the information below:

2. Title:

3. How would you rate the overall donation experience with regards to this particular case?

4. How would you rate Nebraska Organ Recovery's staff you worked with regarding timeliness?

5. How would you rate Nebraska Organ Recovery's staff you worked with regarding courtesy?

6. How knowledgeable was the NORS coordinator of hospital related policies and procedures?

7. Please let us know what worked well on this case?

8. What would you like to see NORS do differently throughout the donation process?

9. Would you like NORS to follow-up with you after completing this survey?

10. Are there hospital staff members that you would like to see recognized for their work on this case? Please share their names with us below.

Nebraska Organ Recovery SystemExit this survey

1. Organ/Tissue Donation Hospital Feedback Form

1. Please fill in the information below:

2. Title:

3. How would you rate the overall donation experience with regards to this particular case?

4. How would you rate Nebraska Organ Recovery's staff you worked with regarding timeliness?

5. How would you rate Nebraska Organ Recovery's staff you worked with regarding courtesy?

6. How knowledgeable was the NORS coordinator of hospital related policies and procedures?

7. Please let us know what worked well on this case?

8. What would you like to see NORS do differently throughout the donation process?

9. Would you like NORS to follow-up with you after completing this survey?

10. Are there hospital staff members that you would like to see recognized for their work on this case? Please share their names with us below.

Nebraska Organ Recovery System
Exit this survey