Standards › Standard 2A › Forms
Form · QUA-FRM-001 · Version 1.1 · Approved by the ASF Expert Committee
Supports: 2A.7
Purpose
Template for the staff safety culture survey. The committee replaces the sample items below with the items of the validated tool selected, without changing its wording.
How to complete
- Use the validated tool exactly as published. Do not change wording or scoring.
- Answer on the scale provided: strongly disagree to strongly agree, or as the tool sets.
- Answer anonymously; do not record names.
- Submit by the closing date.
Checks
| Check | Entry |
|---|---|
| Staff in my area report errors and near misses openly (sample item, replace with tool item) | Scale [EC] |
| I feel safe raising a concern about patient safety (sample item) | Scale [EC] |
| When a mistake is made, the focus is on learning, not blame (sample item) | Scale [EC] |
| I am encouraged to report safety problems (sample item) | Scale [EC] |
| Management acts on safety concerns that are raised (sample item) | Scale [EC] |
Evidence
| Reference | Note |
|---|---|
| EC | AHRQ Hospital Survey on Patient Safety Culture (HSOPSC). Items are samples until the validated tool is chosen. |
| E-009 | ASF Expert Committee consensus. |
Change history
| Version | Date | What changed | Approval |
|---|---|---|---|
| 1.0 | the date of approval | First version (sample items only) | Approved by the ASF Expert Committee |
| 1.1 | the date of approval | Internal quality review: corrected cross-references, status wording and document control | Approved by the ASF Expert Committee |
E-learning for this document
- Incident Reporting, Just Culture and Open Disclosure (T-09)
- Safety Management System & Leadership (MGMT-01)
References
- Accréditation Sans Frontières (2026). ASF Expert Committee consensus on Standard 1. (E-009)