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Hospital Survey on Patient Safety Culture Data Submission
Register for an account
: After completing the form users will receive an email including login information to activate the account.
What You Will Need for Submission
See Full Checklist (PDF
, 87 KB, PDF HELP
- Data Use Agreement: Each hospital is required to sign a Data Use Agreement (DUA) and fax it to 1-888-852-8277.
- Hospital Questionnaire(s) Administered: Users will need to upload a copy of the actual questionnaire(s) administered. If you used a copy of the Spanish questionnaire, please upload this questionnaire as well. We will review the submitted questionnaire(s) and users will receive an approved/not approved email within 3 business days.
NOTE: Your questionnaire will not be approved if
- You made changes to any of the questionnaire item text and/or response options.
- You reordered questionnaire items A1−G1.
- You added new questions between items A1 and G1 and did not add new questions at the end of the questionnaire after Section G, before the demographic questions in Section H.
- Hospital Site Information: Users can upload hospital site information in one of two ways, one at a time on the Data Submission Web site or all at once in an Excel spreadsheet.
- Hospital Site-Level Specifications (PDF, 178 KB, PDF HELP)
- Sample Hospital Site Information Data File (XLSX, 13 KB)
- Hospital Data: Users will need to upload their Hospital survey data, conforming to the Hospital Data Specifications.
- Hospital Survey Data Specifications (PDF, 258 KB, PDF HELP)
- Sample Hospital Survey Data File (XLSX, 13 KB)
For technical assistance on data submission, email DatabasesOnSafetyCulture@westat.com or call 1-888-324-9790.