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.

Question Title

* 1. Which Area/Department are you working in

Question Title

* 2. Your role in the organisation (e.g. grad nurse, medical officer, admin, consultant etc)

Question Title

* 3. I am aware of the need to speak up
when I observe behaviours that may
compromise safety

Question Title

* 4. I have a desire to speak up when I observe
behaviours that may compromise safety

Question Title

* 5. I have the knowledge and skills to know
how to speak up for safety

Question Title

* 6. I have the ability to turn my knowledge into
action and speak up whenever I observe
behaviours that may compromise safety

Question Title

* 7. I am confident to speak up when I observe
behaviours that may compromise safety

Question Title

* 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

Question Title

* 9. In my work setting I welcome being checked

Question Title

* 10. AFTER attending this workshop, I plan to always speak up when
I observe behaviours that may compromise safety

Question Title

* 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

Question Title

* 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?

T