Pilot Test of the Proposed Workplace Safety Supplemental Item Set For the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

Documents and Forms

Document Name Document Type
Form 1 Pilot Test of the Proposed Workplace Safety Supplemental Item Set For the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey Form and Instruction
1 Attachment B: Draft Workplace Safety Cognitive Interview Guide Attachment B - Draft NH Workplace Safety Cognitive Interview Guide.docx Form and Instruction
2 Attachment C: Nursing Home Point of Contact (POC) Instructions Attachment C - Nursing Home Point of Contact (POC) Instructions.docx Form and Instruction
3 Attachment A: Draft Workplace Safety Supplemental Item Set 04CB6620.DOC.docx Form and Instruction
Attachment F Nursing Home Background Information Form Attachment F - Nursing Home Background Information Form.docx Form and Instruction
OMB Cover Letter.docx Cover Letter IC Document
Supporting Statement Part A clean.docx Supporting Statement Part A IC Document
Supporting Statement Part B.docx Supporting Statement Part B IC Document
Attachment D - Survey Invitation and Reminder Notices.docx Attachment D: Survey Invitation and Reminder Notices IC Document
Attachment E.docx Attachment E: Subject Matter Experts and Technical Expert Panel Members IC Document

Information Collection (IC) Details