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Nursing Home Survey on Patient Safety Culture Data Submission
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: After completing the form users will receive an email including login information to activate the account.
Definition of a Nursing Home
- A nursing home is a facility or a special contained area of a facility, that has licensed nursing home beds and is not an assisted living, community care, or independent living facility.
- Nursing homes must be located in the United States or in a U.S. territory.
What You Will Need for Submission
Data Use Agreement: Each nursing home or nursing home system/chain is required to submit a signed Data Use Agreement.
Please sign and return a copy of your DUA via:
- Copy of the 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−E2.
- You added new questions between items A1 and E2 (Please add any additional questions to the end of the questionnaire after Section E, before the demographic questions in Section F).
Nursing Home Site Information: Users will need to provide some characteristics about each nursing home such as bed size and ownership status.
Please use the Site-Level Specifications (PDF, 161 KB, PDF HELP) as a guide when entering your site information.
- Sample Nursing Home Site Information Data File (XLSX, 11 KB)
Nursing Home Survey on Patient Safety Culture Data: Users will need to upload their Nursing Home survey data, conforming to the Nursing Home Survey Data Specifications (PDF, 174 KB, PDF HELP).
- Sample Survey Data File (XLSX, 16 KB)
For technical assistance on data submission, email DatabasesOnSafetyCulture@westat.com or call 1-888-324-9790.