Feedback2.docx

OSPITAL NG MAKATI

Sampaguita corner Gumamela Sts., Brgy. Pembo, Makati City Tel.# 882-6316 to 36 PhilHealth Accredited

FALL PREVENTION AND MANAGEMENT COMMITTEE Please consider taking the time to provide feedback on these survey form.

Demographics 1. Please provide details of yourself and your organization. Area / Ward Position

2. What, if any, do you believe are the STRENGTHS of the Fall Risk Assessment Tool? _______________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

3. What, if any, do you believe are the LIMITATIONS or gaps of the Fall Risk Assessment Tool? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

4. To what extent do you believe the Fall Risk Assessment Tool are clearly written, that is, easy to understand?     

Extremely clear Very Clear Moderately clear Slightly clear Not at all clear

5. Please provide any other comments you have concerning the Fall Risk Assessment Tool? ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

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If you have any queries, please contact the Patient Safety and Risk Management Section at local 410. We look forward to receiving your feedback.

THANK YOU FOR YOUR CONTRIBUTION!