CME Activity Evaluation

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1. Enter your first name:

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2. Enter your last name:

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3. Enter your e-mail address:

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4. Enter your your individual 10-digit National Provider Identifier number:

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5. Are you a Physician, Resident, or Non-Physician?

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6. Select ALL of the RWJBarnabas Health hospitals where you maintain privileges:

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7. Speak up for safety means:

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8. Accurately communicate means:

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9. Focus on the task means:

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10. Exercise and accept a questioning attitude means:

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11. Thoughtfully interact means:

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12. You and me together means:

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13. Select ALL of the tools or techniques that can be used to Speak Up for Safety.

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14. Select ALL of the tools or techniques that can be used to Accurately Communicate.

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15. Select ALL of the tools or techniques that can be used to Focus on the Task.

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16. Select ALL of the tools or techniques that can be used to Exercise and Accept a Questioning Attitude.

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17. Select ALL of the tools or techniques that can be used to Thoughtfully Interact.

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18. Select ALL of the tools or techniques that can be used to support You and me together.

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