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The following questions aim at assessing our safety climate and culture, by use of employee's perceptions of our safety values, processes, reward systems and leadership in 3 Parts. The first part will be closed questions asking for your perception and attitudes in regards to our safety culture. Part 2 will give you the opportunity to provide written feedback, if appropriate and the last part will be asking you for some demographic information used for statistical purpose only. It will take you about 20 minutes to complete all 3 parts. Please respond to all questions honestly and openly and refer to the definition at the beginning of the Survey page whenever needed. Please note that results are only saved once you have answered all mandatory items and pressed the submit button at the end of the survey.

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INSTRUCTIONS Please keep these definitions in mind while taking the survey:
1. Company - refers to your specific employer, Company or Company Affiliate.
2. Company operation - refers to your main work area (Flight Operations, Maintenance, Communication, Administration or Support).
3. Senior Management or Senior Manager - refers to executives that are responsible at Hospital or Aviation Division or Corporate levels.
4. Supervisor -- refers to individuals who manage day-to-day operations (Chief flight nurses, Aviation or Maintenance operations managers).
DEMONSTRATION SURVEY
Shows only a few survey items.


SECTION I: Items (20 questions)
11. I believe that all Airmedical Transport Services employees strive to accomplish our mission goal of "always doing what is right for the patient."

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
22. I believe that Airmedical Transport Services has a trustworthy non-punitive safety reporting process.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
33. My Base provides effective procedures for preventing personal injury.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
44. Airmedical Transport Services provides my Base with adequate resources to support safe operations.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
55. Airmedical Transport Services has an effective process in place to identify any person who may pose a safety hazard on the job due to unsafe behaviors.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
66. I believe that Airmedical Transport Services senior management is strongly committed to safety.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
77. My Base supports a culture in which all employees, and others working at Airmedical Transport Services, feel free to report errors without fear of punishment or management reprisal.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
88. Deliberate violations of standard operating procedures are rare at my Base.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
99. My Base has a positive organizational climate that promotes safety.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
1010. I believe that we HAVE NOT become complacent regarding safety matters because our good safety record.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
 
1111. Managers at my Base are actively involved in the company's safety program.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
1212. Working safely is an integral part of all operations at my Base.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
1313. There is genuine commitment to safe work practices at my Base.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
1414. Airmedical Transport Services regularly conducts thorough safety audits.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
1515. Local Base managers ensure the uniform enforcement of standard operating procedures for all employees.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
1616. My Supervisor listens carefully to employees regardless of job title or rank in the company.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
1717. All Flight Nurses and Medics receive the training necessary to maintain job qualification and certification standards.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
1818. The Airmedical Transport Services pilot performance standards and flight-training program ensure that our pilots meet the required qualifications for specific aircraft types flown.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
1919. Our flight crews (pilots, flight medics and nurses) receive effective Air Medical Resource Management training to improve their communication skills.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
2020. Dispatchers/communicators receive effective Air Medical Resource Management training to improve communication skills.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Not Applicable

Don't Know
 
SECTION II: Open Ended (3 questions)
1.In your view, what situation or specific hazards or other factors may lead to an accident?
2.In your view, what are the most important safety actions that the company can take to reduce the chances of an accident?
3.Do you have any further suggestions or comments about safety in your Company Operation?
 
SECTION III: Demographics (4 questions)
1.Select your primary geographic location or main base.
2.What Company Operation are you associated with?
4.Select your primary Company affiliation (employer) from the list below:
5.How long have you worked at the company?
 

© 2001 - 2021 Dr. Anthony Ciavarelli, Human Factors Associates, Inc. All rights reserved.
This survey form, and its contents, cannot be duplicated in any manner without written permission from Dr. Anthony Ciavarelli.

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