Please complete this questionnaire if you think you hold evidence that you would like to submit to us to help us assess the risks related to the different healthcare science role groupings.

PLEASE DO NOT SUBMIT ANY SENSITIVE PERSONAL DATA IN THIS QUESTIONNAIRE.

You will hear back from us with further information about how to submit your evidence in August.

In the meantime, if you have any questions, please contact us at HCSCommission@professionalstandards.org.uk

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1. Are you responding in a personal capacity or on behalf of an organisation? (Required.)

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2. Your name (Required.)

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3. Email address (or preferred email for further contact from us) (Required.)

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4. Organisation name (if relevant)

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5. If the evidence or observations that you would like to share with us relates to particular roles (or groupings in bold), please tick the relevant boxes:

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6. Do your observations or evidence relate to services in the NHS, the independent sector, both or other? (Required.)

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7. Which country or countries does the evidence come from? (If you have several pieces of evidence, please tick all that apply) (Required.)

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8. Does your evidence relate to: (Required.)

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9. Please describe the type(s) of evidence you would be hoping to share with us. (If you have several pieces of evidence, please tick all that apply) (Required.)

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10. If the evidence is in the form of raw data, in which format is it held? (such as file type or software used)

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11. If the evidence is in the form of raw data, please indicate the approximate file size(s) (if this information is available).

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12. If your evidence is an account of your personal experience(s) as a victim or witness of harm, a near miss, or other patient safety incident, would you be willing to share a written account of this with us at the next stage? This information would be held in line with our Privacy Policy.

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13. Would you anticipate any difficulties with transmitting your evidence to us? (such as potential technical issues, clearance within your organisation, confidentiality) (Required.)

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14. In addition to providing any data and information covered above, would you be willing to participate in a further survey, roundtable, Evidence Working Group, or other engagement relating to the data? (Required.)

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15. Is there anything else you would like to tell us about the evidence that you are thinking of sharing with us, or how you might share it?

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16. Have you also completed the Community of Interest questionnaire? (Required.)

Once you have submitted the questionnaire, if you would like to opt out or change your answers, please email HCSCommission@professionalstandards.org.uk

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