UFCW Pharmacist Survey

Disclaimer: Your personal information will remain private and confidential for internal purposes only unless we receive your express written permission.

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* 1. Name: (First and Last)

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* 2. UFCW Local #

UFCW 8

UFCW 135

UFCW 324

UFCW 648

UFCW 770

UFCW 1167

UFWC 1428

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* 3. Email

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* 4. Cell Phone

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* 5. Hire Date:

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* 6. Average # of hours:

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* 7. Which of the following best describes your schedule?

Alternative 12 hour Schedule

Floating Pharmacist

Other (please specify)

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* 8. Are you full time or part time?

Full Time

Part Time

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* 9. Company and Store #:

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* 10. Retail Hours:

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* 11. Average Scripts by Day

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

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* 12. Average Injections by Day

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

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* 13. Do you have ancillary help?

Yes

Additional Comments

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* 14. Do you know how many ancillary hours are assigned to your pharmacy?

Yes

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* 15. If yes, how many hours are assigned?

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* 16. What tasks do you regularly perform that may be performed by ancillary help?

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* 17. What is the typical wait time for a prescription?

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* 18. When performing an SB 493 consultation, what is the average time it takes to adequately complete a consultation?

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* 19. Are you ever left alone in the pharmacy without any ancillary help?

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* 20. If alone, do you take a lunch break?

Yes

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* 21. If alone, do you take breaks?

Yes

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* 22. Do you close up the pharmacy to take your lunch?

Yes

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* 23. Have you been told that you cannot close pharmacy to take a lunch break?

Yes

Comment

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* 24. When on an “on-call lunch”, do you have an adequate space to eat or rest?

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* 25. What percentage of your weekly shifts, do you work without any ancillary help? (Estimate ok)

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* 26. How often do you work without any ancillary help? Daily? Every other day?

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* 27. On an average shift, how many hours do you work without any ancillary help?

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* 28. Have you ever asked for help, when you were working without any ancillary help?

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* 29. If yes, who did you ask?

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* 30. Were you provided help?

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* 31. Who helped you? Store clerk? Pharm tech?

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* 32. Does being left alone have an impact on your ability to perform your functions as a pharmacist?

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* 33. Has being left alone ever impaired your ability to:

Has being left alone ever resulted in not being able to spend as much time in consultation as would be in the patient's best interest?

Has being left alone ever resulted in not being able to spend as much time checking for opiod abuse as would be best to catch such abuse?

Has being left alone ever resulted in you not be as able as you would like to check with physicians about prescription issues?

Has being left alone prohibited you from filling more prescription due to an inability to contact an MD's office for follow up or contact?

Other (please specify)

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* 34. Optional: Would you be willing to share your story with your elected officials and the media?

Yes