Safe-Ty for Healthcare
Name
*
First Name
Last Name
Email
*
example@example.com
Campus Name
*
Scenario Details
What happened? Provide details of the situation (without providing specific names or other Protected Health Information(PHI))
*
Before having a CrisisAlert badge, what would you have done in a situation like this?
*
How easy was it to use your CrisisAlert badge?
*
1
2
3
4
5
Difficult
Very Easy
1 is Difficult, 5 is Very Easy
To what extent does having CrisisAlert help you to feel safer and supported as a staff member?
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1
2
3
4
5
No Change
Much Safer/Supported
1 is No Change, 5 is Much Safer/Supported
How likely are you to recommend using CrisisAlert to other staff members?
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1
2
3
4
5
6
7
8
9
10
Not Likely
Very Likely
1 is Not Likely, 10 is Very Likely
Would you please share why you chose that number?
*
What feedback or suggestions for improvement do you have?
*
Submit
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