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COVID- 19 Workplace survey
1.
Name of the facility in which you work
American Medical Response
Arbor Health Morton Hospital
Astria Regional Medical Center
Astria Sunnyside Hospital
Astria Toppenish Hospital
Benton-Franklin Health District
Cascade Medical Center
Central Washington Hospital
CHI Franciscan Rehabilitation Hospital
CHI Franciscan St. Clare Hospital
CHI Franciscan St. Joseph Medical Center – Tacoma
EvergreenHealth
Fresenius Kidney Services
Grays Harbor Community Hospital
Island Hospital
Kadlec Regional Medical Center
Kindred Hospital Seattle - First Hill
Kittitas Valley Healthcare
MultiCare Good Samaritan Hospital
MultiCare Tacoma General Hospital
Ocean Beach Hospital
Overlake Hospital & Medical Center
PeaceHealth Peace Island Medical Center
PeaceHealth Southwest Medical Center
PeaceHealth St. John Medical Center
PeaceHealth St. Joseph Medical Center – Bellingham
PeaceHealth United General Medical Center
Providence Holy Family Hospital
Providence Sacred Heart Medical Center
Providence VNA Home Health
Pullman Regional Hospital
Seattle / King County Public Health - Staff
Seattle / King County Public Health - Supervisors
Seattle Children's Hospital
Skagit Regional Health
Skyline Hospital
Snohomish Health District
Spokane Regional Health District
Spokane Veterans Home
St. Luke's Rehabilitation Institute
UW Medical Center - Montlake
UW Medical Center - Northwest
Virginia Mason Medical Center
Walla Walla Veterans Home
Washington Soldiers Home
Washington Veterans Home
Whatcom County Health Department
WhidbeyHealth Medical Center
Other (please specify)
2.
What type of department/unit do you work in?
Adult Outpatient
Community Health Center
Correctional Facility
Critical Care
Emergency
Float/Resource
General Medical-Surgical
Home Health
Imaging
Infection Control
Life Flight
Long Term Care (Assisted Living)
Long Term Care (Skilled Nursing Facility)
Obstetrics
Operating Room
Pediatric ICU/NICU
Pediatric Outpatient
Pediatrics Emergency
Pediatrics General Medical-Surgical
Perioperative Department, not including OR
Private Clinic
Public Health
Radiology
Rehabilitation
Urgent Care
Other (please specify)
3.
Do you work at a facility that has cared for patients with known or suspected COVID-19?
Yes
No
Unsure
4.
Have you provided direct care to a patient with known or suspected COVID-19?
Yes
No
Unsure
5.
How were you informed that you would be caring for a patient with suspected or confirmed COVID-19, including who informed you and when, in relation to your shift?
6.
Has management communicated actions to take if you believe you have been exposed to a patient with known or suspected COVID-19 or if you exhibit symptoms (e.g., fever, cough, shortness of breath)?
Manager notified me
Employee health notified me
I learned from the media
Nobody notified me
Other
7.
What steps did the employer recommend you take?
Follow CDC Guidelines
Follow advise from employee health
I still have unanswered questions
Comment
8.
Were you instructed to stay home from work? (check all that apply)
I was furloughed
I was told to stay home by my manager
I was told to stay home by employee health
I chose to stay home
9.
If you were instructed to stay home from work, is the employer paying you or did the employer instruct you to use PTO/EIB or file for worker’s compensation?
My employer is paying me
Using my PTO or EIB
I don’t know
My employer instructed differently
10.
Currently, do you feel prepared to provide care for a patient with known or suspected COVID-19?
Yes
No
Unsure
11.
Does your facility have a plan in place to care for those with known or suspected COVID-19?
Yes
No
Unsure
12.
Is there a place in your facility to screen and triage patients who come into the facility to make sure that patients with possible COVID-19 are isolated?
Yes
No
Unsure
13.
Does the facility have negative air pressure rooms?
Yes
No
Unsure
14.
Do you know where they are located?
Yes
No
Unsure
15.
Does the facility have N95 respirators available?
Yes
No
Unsure
16.
Is yearly N95 respirator fit testing been provided?
Yes
No
Unsure
My unit uses another type of respirator that does not require fit testing (i.e. CAPR)
17.
Does your facility have PAPRs or reusable respirators?
Yes
No
Unsure
18.
Do you have access to adequate supplies of PPE (respirators, eye protection, face shield, gloves) to do your work?
Yes
No
Unsure
19.
Has management assigned/asked for staff volunteers dedicated to care for patients with COVID-19?
Yes
No
Unsure
20.
Has your management/supervisor discussed with frontline staff your facility’s response plan for caring for patients with known or suspected COVID-19?
Yes
No
Unsure
21.
What type of preparation and training has your facility conducted? (check all that apply)
Adding questions to intake screening
Posting of CDC checklist for patients with known or suspected COVID-19 on your unit
Posting phone number of state Department of Health
Plan for patient transport from clinic/community to ED
Plan for patient transport from ED to inpatient setting
Setting up separate screening areas for potential patients
Setting up isolation areas specific for patients with known or suspected COVID-19
CDC recommended personal protective equipment (PPE) is immediately available to staff
CDC recommended PPE kits ready for use and practice for clinic, public health, ambulatory setting
CDC recommended PPE kits ready for use and practice for ED or Urgent Care setting
Training staff on current infection control protocols
Employer-provided training on when to use PPE, donning, and doffing.
Discussed safety and patient care delivery in daily huddle
Clinical protocols for aerosol-generating procedures (bronchoscopy, intubation, CPR, respiratory suctioning, etc.)
Appropriate cleaning materials
I do not know
Other (please specify)
22.
If training is being conducted, what methods of instruction are being used?
None
General meetings/forums
Literature provided
Videos
Webinars
Inservices/huddles
Review of updated PPE procedures
Repetitive hands-on drills appropriate to your role including donning and doffing PPE.
23.
Are you afraid to come to work?
No
If Yes, please explain
24.
What additional information do you need to feel safe and informed (e.g., effectiveness of employer response, resources, personal support)?
25.
Additional Comments (is there anything else your union can be doing?)
26.
Contact Information (Optional)
Name
Email
Cell Phone
Current Progress,
0 of 26 answered
