FDA Safety Communication Readership Survey

Form Approved: OMB No. 0910-0341 Expiration Date: XX/XX/XXXX. See OMB Statement at the end of the survey

FDA Safety Communication: <insert SC title> <insert date of SC release>

PLEASE HELP US (TO HELP YOU)...

We need to hear from you so we can evaluate and improve our Safety Communications as well as the overall effectiveness of the Safety Communication program. Please take a few minutes to answer the questions below. We will publish a summary of the results. All questions relate to this Safety Communication.

Your responses will be kept confidential. Thank you for your assistance.

1. A. Were you able to identify the problem this Safety Communication addresses?  Yes

 No

B. If no, why not?

2. A. Were you able to easily understand the problem addressed in this Safety Communication?  Yes

 No

B. If no, why not?

3. A. Did you understand the actions for reducing risk?  Yes

 No

B. If no, why not?

4. A. Did you find the information contained in this Safety Communication useful?  Yes

 No

B. If no, why not?

5. Did you find the information contained in this Safety Communication to be timely?  Yes

 No

6. A. Were you aware of the problem addressed in this Safety Communication prior to reading it?  Yes

 No

B. If yes, how did you first become aware of the problem?

a____ personal experience e____ manufacturer recall

b____ coworkers, friends, or family f____ manufacturer notification

c____ professional bulletin g____ your organization’s management

d____ professional symposium h____ print media (e.g., newspaper)

i electronic media (e.g. web)

j social media (e.g., Twitter, Facebook)

k my health care provider

l. Other (please specify)___________________

7. A. Have you taken any actions to eliminate or reduce the risk as a result of the information in this Safety Communication?

 Yes

• No

2. If yes, what actions did you take?

C. If no, why not?

a_____ already took action prior to Safety Communication

b_____ actions planned prior to Safety Communication but not yet taken

c_____ actions planned based on Safety Communication but not yet taken

d_____ risk was never applicable to our operation

e_____ felt risk did not warrant action

8. A. Have you signed up to receive future Safety Communications electronically?

 Yes

• No

B. If no, why not?

9. I am a:

a____ Hospital Administrator f____ Quality Assurance Manager

b____ Risk Manager g____ Home Health Care Administrator

c____ Director of Nursing h____ Nursing Home Administrator

d____ Biomedical/Clinical Engineer I____ Hospice Administrator

j Medical Device Industry Representative

k Student (e.g., medical, nursing, public health)

l. Health Educator

m. Patient

n. Caregiver

o. Patient Advocacy Group Representative

e____ Safety Director p____ Other (please specify)_____________________________

10. I have the following suggestions for improving this FDA Safety Communication:

Public reporting burden for this collection of information is estimated to average 0.17 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to:

Department of Health and Human Services
Food and Drug Administration
Office of Chief Information Officer
Paperwork Reduction Act (PRA) Staff
[email protected]

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.