2025 Annual Hospital Child Passenger Safety / Car Seat Survey

Thank you for taking the time to complete this survey. Your responses will guide child passenger safety training programs and educational resources for the medical community and families.

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* 1. I prefer to receive future surveys by:

Email

Mail

Both

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* 2. General Information

Person Completing the Survey:

Title:

Telephone #:

Email:

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* 3. Hospital Information

Hospital: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

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* 4. County

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* 5. Maternity Nurse Manager

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* 6. Maternity Discharge Contact:

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* 7. Chair of Pediatrics Department:

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* 8. Chair of Obstetrics Department:

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* 9. Hospital Educational Coordinator:

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* 10. Approximate number of babies born annually: