This survey is Private & Confidential, Senior Management of Codeblue will only have access.

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* 1. Location and date of Incident (Event/Venue)

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* 2. Can you describe in a few short lines what happened?

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* 3. How would you rate the professionalism of our staff throughout your interaction?

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* 4. Where you treated with dignity and respect throughout your treatment?

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* 5. If you were in pain, was it managed?

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* 6. Would you describe your transfer to hospital reasonably comfortable and safe?

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* 7. Were you informed of your treatment and interventions (if any) at all times?

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* 8. Can you rate your satisfaction of the care and treatment you received?

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* 9. If you have any other feedback about your experience, please write in the space below.

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* 10. Would you like to be contacted by the Codeblue Aftercare Team

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