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Community Pharmacy Survey on Patient Safety Culture DUA Submission Portal

Data Use Agreement

Each pharmacy or system/chain wishing to participate in the Community Pharmacy Survey on Patient Safety Culture Database is required to sign a Data Use Agreement (DUA) each submission period. The DUA assures the confidentiality of the data and explains how the data will be used. The completed and signed DUA can be submitted at any time. The DUA can be uploaded directly to the submission system through the DUA submission portal, emailed to DatabasesOnSafetyCulture@westat.com, or faxed to 1-888-852-8277.

Pharmacy Data Use Agreement (PDF, 142 KB, PDF HELP)

For technical assistance, please email DatabasesOnSafetyCulture@westat.com or call 1-888-324-9790.