Form 57.75Za Healthcare Personnel Safety Component Facility Survey

The National Healthcare Safety Network (NHSN)

Za_AnnualFac Surv.ppt

Healthcare Personnel Safety Component Facility Survey

OMB: 0920-0666

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  1. PROCEDURE DATA

 

  1. *Inpatient

  1. *Outpatient

  1. *Total number of surgeries

  

  1. *FACILITY INFORMATION

  1. *Number of:

  1. Acute care beds

 

  1. Patient admissions

 

  1. Inpatient days

 

  1. Outpatient visits

 

  1. Total number of part-time personnel

 

  1. Total number of full-time personnel

 

 

  1. SELECTED HEALTHCARE WORKER OCCUPATIONAL GROUPS

  1. *Occupation

  1. *Number of HCWs

  1. *Number of FTEs

  1. Registered nurse

  

  1. Licensed practical nurse

  

  1. Nurse practitioner/clinical nurse specialist

  

  1. Nursing assistant/patient care technician

  

  1. Nurse midwife

  

  1. Nurse anesthetist

  

  1. Attendant/orderly

  

  1. Respiratory technician/therapist

  

  1. Phlebotomist

  

  1. IV team

  

  1. Clinical laboratory technician

  

  1. OR/surgical technician

  

  1. Dental assistant/technician

  

  1. Dental hygienist

  

  1. Dentist

  

  1. Housekeeper

  

  1. Laundry staff

  

  1. Maintenance/engineering service

  

  1. Central supply staff

  

  1. Physician assistants

  

  1. Intern/resident

  

  1. Fellow

  

  1. Attending physician

  

 
File Typeapplication/vnd.ms-powerpoint
File TitleSlide 1
AuthorJasie L. Jackson
Last Modified Byrfp9
File Modified2007-07-26
File Created2007-04-19
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