response.questback.com
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193.122.1.39
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Submitted URL: https://response.questback.com/dnvbusinessassurance/bdxkynmw7f
Effective URL: https://response.questback.com/isa/qbv.dll/bylink?p=d25aKJORUtOxPqQ9McCHvsGoD5PhSPZLiuPfB-CgkyPVuk4ULGfB4_Isdrs2ivX90
Submission Tags: falconsandbox
Submission: On April 24 via api from US — Scanned from DE
Effective URL: https://response.questback.com/isa/qbv.dll/bylink?p=d25aKJORUtOxPqQ9McCHvsGoD5PhSPZLiuPfB-CgkyPVuk4ULGfB4_Isdrs2ivX90
Submission Tags: falconsandbox
Submission: On April 24 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: verdiene — POST /isa/qbv.dll/SubmitQuestAnswer
<form method="POST" name="verdiene" action="/isa/qbv.dll/SubmitQuestAnswer">
<input type="hidden" name="questIsoLanguage" value="en-GB">
<div class="content">
<div class="questdescription"></div>
<div class="entermemberid"></div>
<div class="anonymityinfo"></div>
<div class="warningtext"></div>
<div id="surveyquestions"><input type="hidden" name="parameters"
value="slDC07fByDqp1ShadCo25Usq5V_GqLAUGpyCzDthCvQZ7IVmxFUyf7hjnfZ1tBMpohgjRl2PdyMJqM5WJ8puRiXRZ-WezJ6Ct4woa_2Bm9AyqCKdACK2QhBx2r5FbzcvrVE8mxrDpWgo-h5w_J_RcuwnFGkRY3huG1aIUPqwgn-5Nd_rP4eM9l7IuxkKmJ2EZEnfsmrqFxA2Nzjp-SD2J0jTby_5mBlbf2YJCdi9e_cvlfSuSCPsxZgo8iPte0YqcesjSwiCtnbcOq3tbazV_oxNnSE2JHbR2fC2DNk_x0TjVIDACkFAFRaWM8p7x5coIhVmEiydXeZThkPxDFc74bVNDdlp0MVZ5qugd7f4Yz5N8jL1wFd9lqP2X3ogq7cLBrBa_qGtmTbO17d4LMvPJ6yRVrT-9LB6mSbYh715K1247TlINfMam70pRAZHVubF_H88J9PL7YYHMHYVcLJbpk05c566LkI397c6NH0J7EudrJpufctkleiJzt3JkiJutXs-G1HT9caMnI0rhbqEYqiekBOHHgy2IjvX8pv_Bq6M6caeK_8x6CWlPELQ56DAzvFqBi3JzP8RuBTDuc39rM7I5eYCWH5K2SByY0nFKGE5s2-2SmsudNp-fe2mERlEyILEVAk5W8t6AsLra3B7pIAp-TO_bZ52RI6HseRGEWyTEHgxjwg511AylmJgSyEKeqFGnwPncrk25Nq2aDlLJVlbGd5GDARspk4V6EaqrzvNJHBfcKXRtZyOJUYFXIb9-tbNPQqg6D4sAaf3FwV6Jnxw9oHhSMoaFloEo2KOSh41">
<script type="text/javascript">
<!--
function CheckRouting() {
return true
}
//
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</script>
<div class="hr">
<hr noshade="" size="1" color="#808080">
</div>
<a style="font-size:1px;padding:0;margin:0;" name="93768296"></a>
<fieldset id="93768296">
<legend><span class="IEWrap"><b>Please provide some information about your company:</b></span></legend>
<div class="fieldset-content matrixshortopen">
<div class="matrixSubQuestion">
<label for="1_1"><abbr title="Required"> * </abbr>The name of the Hospital</label>
<input id="1_1" type="text" title="The name of the Hospital" class="AnswerInput" name="REPLY_93768473" size="60" value="">
</div>
<div class="matrixSubQuestion">
<label for="1_2"><abbr title="Required"> * </abbr>The name of the site/branch</label>
<input id="1_2" type="text" title="The name of the site/branch" class="AnswerInput" name="REPLY_93768474" size="60" value="">
</div>
<div class="matrixSubQuestion">
<label for="1_3"><abbr title="Required"> * </abbr>Your business email</label>
<input id="1_3" type="text" title="Your business email" class="AnswerInput" name="REPLY_93768475" size="60" value="">
</div>
<div class="matrixSubQuestion">
<label for="1_4"><abbr title="Required"> * </abbr>Your name</label>
<input id="1_4" type="text" title="Your name" class="AnswerInput" name="REPLY_93768476" size="60" value="">
</div>
</div>
</fieldset>
<div class="hr">
<hr noshade="" size="1" color="#808080">
</div>
<a style="font-size:1px;padding:0;margin:0;" name="93767784"></a>
<div class="comments">
<h2><strong>Section 1 – Overall satisfaction </strong></h2><em><span style="font-size:11.0pt;line-height:107%;font-family:'Calibri',sans-serif;">[Dear Customer, please provide your feedback on your overall experience with DNV.]</span></em>
</div>
<fieldset id="93767784">
<legend><span class="IEWrap"><b><abbr title="Required"> * </abbr>How Satisfied are you with the quality of services provided by DNV?</b></span></legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="2_515284456" title="Very dissatisfied" type="radio" value="515284456" name="REPLY_93767784"><label for="2_515284456" class="verti">Very dissatisfied</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="2_515284457" title="Dissatisfied" type="radio" value="515284457" name="REPLY_93767784"><label for="2_515284457" class="verti">Dissatisfied</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="2_515284458" title="Neutral" type="radio" value="515284458" name="REPLY_93767784"><label for="2_515284458" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="2_515284459" title="Satisfied" type="radio" value="515284459" name="REPLY_93767784"><label for="2_515284459" class="verti">Satisfied</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="2_515284460" title="Very Satisfied" type="radio" value="515284460" name="REPLY_93767784"><label for="2_515284460" class="verti">Very Satisfied</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93768478"></a>
<fieldset id="93768478">
<legend><span class="IEWrap"><b><abbr title="Required"> * </abbr>How likely are you to recommend DNV to a colleague and/or business partner? (0-Not at all likely, 10-Extremely Likely).</b></span></legend>
<div class="fieldset-content singlehorz">
<table cellpadding="0" cellspacing="4" border="0" class="horizontal" role="presentation">
<tbody>
<tr>
<td>
<div class="singlehorz-item-wrapper even" style="margin-top: 0px;"><input id="3_515289681" title="0" type="radio" value="515289681" name="REPLY_93768478"><label for="3_515289681" class="odd">0</label></div>
<div class="singlehorz-item-wrapper" style="margin-top: 0px;"><input id="3_515289682" title="1" type="radio" value="515289682" name="REPLY_93768478"><label for="3_515289682">1</label></div>
<div class="singlehorz-item-wrapper even" style="margin-top: 0px;"><input id="3_515289683" title="2" type="radio" value="515289683" name="REPLY_93768478"><label for="3_515289683" class="odd">2</label></div>
<div class="singlehorz-item-wrapper" style="margin-top: 0px;"><input id="3_515289684" title="3" type="radio" value="515289684" name="REPLY_93768478"><label for="3_515289684">3</label></div>
<div class="singlehorz-item-wrapper even" style="margin-top: 0px;"><input id="3_515289685" title="4" type="radio" value="515289685" name="REPLY_93768478"><label for="3_515289685" class="odd">4</label></div>
<div class="singlehorz-item-wrapper" style="margin-top: 0px;"><input id="3_515289686" title="5" type="radio" value="515289686" name="REPLY_93768478"><label for="3_515289686">5</label></div>
<div class="singlehorz-item-wrapper even" style="margin-top: 0px;"><input id="3_515289687" title="6" type="radio" value="515289687" name="REPLY_93768478"><label for="3_515289687" class="odd">6</label></div>
<div class="singlehorz-item-wrapper" style="margin-top: 0px;"><input id="3_515289688" title="7" type="radio" value="515289688" name="REPLY_93768478"><label for="3_515289688">7</label></div>
<div class="singlehorz-item-wrapper even" style="margin-top: 0px;"><input id="3_515289689" title="8" type="radio" value="515289689" name="REPLY_93768478"><label for="3_515289689" class="odd">8</label></div>
<div class="singlehorz-item-wrapper" style="margin-top: 0px;"><input id="3_515289690" title="9" type="radio" value="515289690" name="REPLY_93768478"><label for="3_515289690">9</label></div>
<div class="singlehorz-item-wrapper even" style="margin-top: 0px;"><input id="3_515289691" title="10" type="radio" value="515289691" name="REPLY_93768478"><label for="3_515289691" class="odd">10</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93768957"></a>
<fieldset id="93768957">
<legend><span class="IEWrap"><b><abbr title="Required"> * </abbr>How likely is it that you would prefer DNV over alternative suppliers in the future?</b></span></legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="4_515289696" title="Not at all likely" type="radio" value="515289696" name="REPLY_93768957"><label for="4_515289696" class="verti">Not at all likely</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="4_515289697" title="Unlikely" type="radio" value="515289697" name="REPLY_93768957"><label for="4_515289697" class="verti">Unlikely</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="4_515289698" title="Neutral" type="radio" value="515289698" name="REPLY_93768957"><label for="4_515289698" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="4_515289699" title="Likely" type="radio" value="515289699" name="REPLY_93768957"><label for="4_515289699" class="verti">Likely</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="4_515289700" title="Extremely likely" type="radio" value="515289700" name="REPLY_93768957"><label for="4_515289700" class="verti">Extremely likely</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93768959"></a>
<fieldset id="93768959">
<legend><label for="5_0"><span class="IEWrap"><b>What would you suggest we improve regarding the accreditation survey process?</b></span></label></legend>
<div class="fieldset-content openanswerlong"><textarea id="5_0" wrap="yes" rows="6" name="REPLY_93768959" cols="50" maxlength="4000"></textarea><span class="text-feedback">0/4000</span></div>
</fieldset>
<div class="hr">
<hr noshade="" size="1" color="#808080">
</div>
<a style="font-size:1px;padding:0;margin:0;" name="93769186"></a>
<div class="comments">
<h2><strong><span>Section 2 – Service Delivery</span></strong></h2>
</div>
<fieldset id="93769186">
<legend><span class="IEWrap"><b>The survey team was prepared upon arrival at our facility.</b></span></legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="6_515290631" title="Completely Disagree" type="radio" value="515290631" name="REPLY_93769186"><label for="6_515290631" class="verti">Completely Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="6_515290632" title="Disagree" type="radio" value="515290632" name="REPLY_93769186"><label for="6_515290632" class="verti">Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="6_515290633" title="Neutral" type="radio" value="515290633" name="REPLY_93769186"><label for="6_515290633" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="6_515290634" title="Agree" type="radio" value="515290634" name="REPLY_93769186"><label for="6_515290634" class="verti">Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="6_515290635" title="Completely Agree" type="radio" value="515290635" name="REPLY_93769186"><label for="6_515290635" class="verti">Completely Agree</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93769362"></a>
<fieldset id="93769362">
<legend><span class="IEWrap"><b>The survey team related well to our staff at all levels of the organization. </b></span></legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="7_515290711" title="Completely Disagree" type="radio" value="515290711" name="REPLY_93769362"><label for="7_515290711" class="verti">Completely Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="7_515290712" title="Disagree" type="radio" value="515290712" name="REPLY_93769362"><label for="7_515290712" class="verti">Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="7_515290713" title="Neutral" type="radio" value="515290713" name="REPLY_93769362"><label for="7_515290713" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="7_515290714" title="Agree" type="radio" value="515290714" name="REPLY_93769362"><label for="7_515290714" class="verti">Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="7_515290715" title="Completely Agree" type="radio" value="515290715" name="REPLY_93769362"><label for="7_515290715" class="verti">Completely Agree</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93769384"></a>
<fieldset id="93769384">
<legend><span class="IEWrap"><b>The survey team’s opening session was clear and informative about the survey goals and expectations. </b></span></legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="8_515290817" title="Completely Disagree" type="radio" value="515290817" name="REPLY_93769384"><label for="8_515290817" class="verti">Completely Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="8_515290818" title="Disagree" type="radio" value="515290818" name="REPLY_93769384"><label for="8_515290818" class="verti">Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="8_515290819" title="Neutral" type="radio" value="515290819" name="REPLY_93769384"><label for="8_515290819" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="8_515290820" title="Agree" type="radio" value="515290820" name="REPLY_93769384"><label for="8_515290820" class="verti">Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="8_515290821" title="Completely Agree" type="radio" value="515290821" name="REPLY_93769384"><label for="8_515290821" class="verti">Completely Agree</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93769392"></a>
<fieldset id="93769392">
<legend><span class="IEWrap"><b>The survey team members were respectful and minimized disruptions in patient care. </b></span></legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="9_515290993" title="Completely Disagree" type="radio" value="515290993" name="REPLY_93769392"><label for="9_515290993" class="verti">Completely Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="9_515290994" title="Disagree" type="radio" value="515290994" name="REPLY_93769392"><label for="9_515290994" class="verti">Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="9_515290995" title="Neutral" type="radio" value="515290995" name="REPLY_93769392"><label for="9_515290995" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="9_515290996" title="Agree" type="radio" value="515290996" name="REPLY_93769392"><label for="9_515290996" class="verti">Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="9_515290997" title="Completely Agree" type="radio" value="515290997" name="REPLY_93769392"><label for="9_515290997" class="verti">Completely Agree</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93769495"></a>
<fieldset id="93769495">
<legend><span class="IEWrap"><b>The DNV team made themselves available to address any questions or concerns throughout the survey process.</b></span></legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="10_515291706" title="Completely Disagree" type="radio" value="515291706" name="REPLY_93769495"><label for="10_515291706" class="verti">Completely Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="10_515291707" title="Disagree" type="radio" value="515291707" name="REPLY_93769495"><label for="10_515291707" class="verti">Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="10_515291708" title="Neutral" type="radio" value="515291708" name="REPLY_93769495"><label for="10_515291708" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="10_515291709" title="Agree" type="radio" value="515291709" name="REPLY_93769495"><label for="10_515291709" class="verti">Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="10_515291710" title="Completely Agree" type="radio" value="515291710" name="REPLY_93769495"><label for="10_515291710" class="verti">Completely Agree</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93769861"></a>
<fieldset id="93769861">
<legend><span class="IEWrap"><b>The clinician provided a thorough review of our patient care processes as outlined in the agenda.</b></span></legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="11_515291730" title="Completely Disagree" type="radio" value="515291730" name="REPLY_93769861"><label for="11_515291730" class="verti">Completely Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="11_515291731" title="Disagree" type="radio" value="515291731" name="REPLY_93769861"><label for="11_515291731" class="verti">Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="11_515291732" title="Neutral" type="radio" value="515291732" name="REPLY_93769861"><label for="11_515291732" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="11_515291733" title="Agree" type="radio" value="515291733" name="REPLY_93769861"><label for="11_515291733" class="verti">Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="11_515291734" title="Completely Agree" type="radio" value="515291734" name="REPLY_93769861"><label for="11_515291734" class="verti">Completely Agree</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93769867"></a>
<fieldset id="93769867">
<legend><span class="IEWrap"><b>The Quality Management session was helpful in understanding the value of quality metrics and how data is driving improved outcomes.</b></span></legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="12_515291744" title="Completely Disagree" type="radio" value="515291744" name="REPLY_93769867"><label for="12_515291744" class="verti">Completely Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="12_515291745" title="Disagree" type="radio" value="515291745" name="REPLY_93769867"><label for="12_515291745" class="verti">Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="12_515291746" title="Neutral" type="radio" value="515291746" name="REPLY_93769867"><label for="12_515291746" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="12_515291747" title="Agree" type="radio" value="515291747" name="REPLY_93769867"><label for="12_515291747" class="verti">Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="12_515291748" title="Completely Agree" type="radio" value="515291748" name="REPLY_93769867"><label for="12_515291748" class="verti">Completely Agree</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93769871"></a>
<fieldset id="93769871">
<legend><span class="IEWrap"><b>The Physical Environment document review and building tours were helpful in understanding the applicable requirements and to maintain a safe and effective physical space for patient care to thrive. </b></span>
</legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="13_515301785" title="Completely Disagree" type="radio" value="515301785" name="REPLY_93769871"><label for="13_515301785" class="verti">Completely Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="13_515301786" title="Disagree" type="radio" value="515301786" name="REPLY_93769871"><label for="13_515301786" class="verti">Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="13_515301787" title="Neutral" type="radio" value="515301787" name="REPLY_93769871"><label for="13_515301787" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="13_515301788" title="Agree" type="radio" value="515301788" name="REPLY_93769871"><label for="13_515301788" class="verti">Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="13_515301789" title="Completely Agree" type="radio" value="515301789" name="REPLY_93769871"><label for="13_515301789" class="verti">Completely Agree</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93769880"></a>
<fieldset id="93769880">
<legend><span class="IEWrap"><b>Enough time was given for you to tell us about your processes and how you meet applicable requirements.</b></span></legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="14_515301833" title="Completely Disagree" type="radio" value="515301833" name="REPLY_93769880"><label for="14_515301833" class="verti">Completely Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="14_515301834" title="Disagree" type="radio" value="515301834" name="REPLY_93769880"><label for="14_515301834" class="verti">Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="14_515301835" title="Neutral" type="radio" value="515301835" name="REPLY_93769880"><label for="14_515301835" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="14_515301836" title="Agree" type="radio" value="515301836" name="REPLY_93769880"><label for="14_515301836" class="verti">Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="14_515301837" title="Completely Agree" type="radio" value="515301837" name="REPLY_93769880"><label for="14_515301837" class="verti">Completely Agree</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93769883"></a>
<fieldset id="93769883">
<legend><span
class="IEWrap"><b>Implementing the ISO 9001 standard has helped us minimize our variances, helped us improve patient care, and continues to positively impact our Quality Management system. (Select N/A if ISO 9001 is not yet applicable to your organization).</b></span>
</legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="15_515322070" title="Completely Disagree" type="radio" value="515322070" name="REPLY_93769883"><label for="15_515322070" class="verti">Completely Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="15_515322071" title="Disagree" type="radio" value="515322071" name="REPLY_93769883"><label for="15_515322071" class="verti">Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="15_515322072" title="Neutral" type="radio" value="515322072" name="REPLY_93769883"><label for="15_515322072" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="15_515322073" title="Agree" type="radio" value="515322073" name="REPLY_93769883"><label for="15_515322073" class="verti">Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="15_515322074" title="Completely Agree" type="radio" value="515322074" name="REPLY_93769883"><label for="15_515322074" class="verti">Completely Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="15_515506919" title="N/A" type="radio" value="515506919" name="REPLY_93769883"><label for="15_515506919" class="verti">N/A</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93769941"></a>
<fieldset id="93769941">
<legend><span class="IEWrap"><b>The survey team’s end-of-survey closing session was clearly communicated so that the organization understood all identified non-conformities and why they did not meet applicable requirements. </b></span>
</legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="16_515322175" title="Completely Disagree" type="radio" value="515322175" name="REPLY_93769941"><label for="16_515322175" class="verti">Completely Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="16_515322176" title="Disagree" type="radio" value="515322176" name="REPLY_93769941"><label for="16_515322176" class="verti">Disagree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="16_515322177" title="Neutral" type="radio" value="515322177" name="REPLY_93769941"><label for="16_515322177" class="verti">Neutral</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="16_515322178" title="Agree" type="radio" value="515322178" name="REPLY_93769941"><label for="16_515322178" class="verti">Agree</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="16_515322179" title="Completely Agree" type="radio" value="515322179" name="REPLY_93769941"><label for="16_515322179" class="verti">Completely Agree</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
<div class="hr">
<hr noshade="" size="1" color="#808080">
</div>
<a style="font-size:1px;padding:0;margin:0;" name="93773057"></a>
<div class="comments">
<h2><strong>Section 3 – Surveyor’s Skills</strong></h2>
</div>
<fieldset id="93773057">
<legend><label for="17_0"><span class="IEWrap"><b>Please enter the name of Surveyor #1:</b></span></label></legend>
<div class="fieldset-content openanswershort"><input id="17_0" type="text" class="AnswerInput" name="REPLY_93773057" size="60" value="" maxlength="255"><span class="text-feedback">0/255</span></div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93770149"></a>
<fieldset id="93770149">
<legend><span class="IEWrap"><b>On a scale of 1-5 (1 completely dissatisfied – 5 completely satisfied) please rate each of the following:</b></span></legend>
<div class="fieldset-content singlematrix">
<table class="matrix" border="0" cellspacing="0" cellpadding="4" summary="This is a matrix table." width="100%" role="presentation" style="display: table;">
<thead>
<tr class="even">
<th></th>
<th width="8%" id="18c0" align="center" valign="bottom">1 (Very low)</th>
<th width="8%" id="18c1" align="center" valign="bottom">2</th>
<th width="8%" id="18c2" align="center" valign="bottom">3</th>
<th width="8%" id="18c3" align="center" valign="bottom">4</th>
<th width="8%" id="18c4" align="center" valign="bottom">5 (Very high)</th>
</tr>
</thead>
<tbody>
<tr role="radiogroup">
<th id="18r1">Communication skills</th>
<td headers="18r1 18c0" align="center"><input id="18_1_0" type="radio" class="checkRadio" title="Communication skills - 1 (Very low)" value="515353051" name="REPLY_93770230"></td>
<td headers="18r1 18c1" align="center"><input id="18_1_1" type="radio" class="checkRadio" title="Communication skills - 2" value="515353052" name="REPLY_93770230"></td>
<td headers="18r1 18c2" align="center"><input id="18_1_2" type="radio" class="checkRadio" title="Communication skills - 3" value="515353053" name="REPLY_93770230"></td>
<td headers="18r1 18c3" align="center"><input id="18_1_3" type="radio" class="checkRadio" title="Communication skills - 4" value="515353054" name="REPLY_93770230"></td>
<td headers="18r1 18c4" align="center"><input id="18_1_4" type="radio" class="checkRadio" title="Communication skills - 5 (Very high)" value="515353055" name="REPLY_93770230"></td>
</tr>
<tr role="radiogroup" class="even">
<th id="18r2">Demeanour</th>
<td headers="18r2 18c0" align="center"><input id="18_2_0" type="radio" class="checkRadio" title="Demeanour - 1 (Very low)" value="515353056" name="REPLY_93770231"></td>
<td headers="18r2 18c1" align="center"><input id="18_2_1" type="radio" class="checkRadio" title="Demeanour - 2" value="515353057" name="REPLY_93770231"></td>
<td headers="18r2 18c2" align="center"><input id="18_2_2" type="radio" class="checkRadio" title="Demeanour - 3" value="515353058" name="REPLY_93770231"></td>
<td headers="18r2 18c3" align="center"><input id="18_2_3" type="radio" class="checkRadio" title="Demeanour - 4" value="515353059" name="REPLY_93770231"></td>
<td headers="18r2 18c4" align="center"><input id="18_2_4" type="radio" class="checkRadio" title="Demeanour - 5 (Very high)" value="515353060" name="REPLY_93770231"></td>
</tr>
<tr role="radiogroup">
<th id="18r3">Professionalism</th>
<td headers="18r3 18c0" align="center"><input id="18_3_0" type="radio" class="checkRadio" title="Professionalism - 1 (Very low)" value="515353061" name="REPLY_93770232"></td>
<td headers="18r3 18c1" align="center"><input id="18_3_1" type="radio" class="checkRadio" title="Professionalism - 2" value="515353062" name="REPLY_93770232"></td>
<td headers="18r3 18c2" align="center"><input id="18_3_2" type="radio" class="checkRadio" title="Professionalism - 3" value="515353063" name="REPLY_93770232"></td>
<td headers="18r3 18c3" align="center"><input id="18_3_3" type="radio" class="checkRadio" title="Professionalism - 4" value="515353064" name="REPLY_93770232"></td>
<td headers="18r3 18c4" align="center"><input id="18_3_4" type="radio" class="checkRadio" title="Professionalism - 5 (Very high)" value="515353065" name="REPLY_93770232"></td>
</tr>
<tr role="radiogroup" class="even">
<th id="18r4">Overall rating</th>
<td headers="18r4 18c0" align="center"><input id="18_4_0" type="radio" class="checkRadio" title="Overall rating - 1 (Very low)" value="515353066" name="REPLY_93770233"></td>
<td headers="18r4 18c1" align="center"><input id="18_4_1" type="radio" class="checkRadio" title="Overall rating - 2" value="515353067" name="REPLY_93770233"></td>
<td headers="18r4 18c2" align="center"><input id="18_4_2" type="radio" class="checkRadio" title="Overall rating - 3" value="515353068" name="REPLY_93770233"></td>
<td headers="18r4 18c3" align="center"><input id="18_4_3" type="radio" class="checkRadio" title="Overall rating - 4" value="515353069" name="REPLY_93770233"></td>
<td headers="18r4 18c4" align="center"><input id="18_4_4" type="radio" class="checkRadio" title="Overall rating - 5 (Very high)" value="515353070" name="REPLY_93770233"></td>
</tr>
</tbody>
</table>
<div class="webks-responsive-table matrix" style="display: none;">
<div class="row row-0"><label class="title col-0"><span class="grouptitle col-0">Communication skills</span></label><label class="title col-1"><span class="value col-1"><input id="18_1_0" type="radio" class="checkRadio"
title="Communication skills - 1 (Very low)" value="515353051" name="REPLY_93770230" disabled="disabled"></span>1 (Very low)</label><label class="title col-2"><span class="value col-2"><input id="18_1_1" type="radio"
class="checkRadio" title="Communication skills - 2" value="515353052" name="REPLY_93770230" disabled="disabled"></span>2</label><label class="title col-3"><span class="value col-3"><input id="18_1_2" type="radio"
class="checkRadio" title="Communication skills - 3" value="515353053" name="REPLY_93770230" disabled="disabled"></span>3</label><label class="title col-4"><span class="value col-4"><input id="18_1_3" type="radio"
class="checkRadio" title="Communication skills - 4" value="515353054" name="REPLY_93770230" disabled="disabled"></span>4</label><label class="title col-5"><span class="value col-5"><input id="18_1_4" type="radio"
class="checkRadio" title="Communication skills - 5 (Very high)" value="515353055" name="REPLY_93770230" disabled="disabled"></span>5 (Very high)</label></div>
<div class="row row-1 even"><label class="title col-0"><span class="grouptitle col-0">Demeanour</span></label><label class="title col-1"><span class="value col-1"><input id="18_2_0" type="radio" class="checkRadio"
title="Demeanour - 1 (Very low)" value="515353056" name="REPLY_93770231" disabled="disabled"></span>1 (Very low)</label><label class="title col-2"><span class="value col-2"><input id="18_2_1" type="radio" class="checkRadio"
title="Demeanour - 2" value="515353057" name="REPLY_93770231" disabled="disabled"></span>2</label><label class="title col-3"><span class="value col-3"><input id="18_2_2" type="radio" class="checkRadio" title="Demeanour - 3"
value="515353058" name="REPLY_93770231" disabled="disabled"></span>3</label><label class="title col-4"><span class="value col-4"><input id="18_2_3" type="radio" class="checkRadio" title="Demeanour - 4" value="515353059"
name="REPLY_93770231" disabled="disabled"></span>4</label><label class="title col-5"><span class="value col-5"><input id="18_2_4" type="radio" class="checkRadio" title="Demeanour - 5 (Very high)" value="515353060"
name="REPLY_93770231" disabled="disabled"></span>5 (Very high)</label></div>
<div class="row row-2"><label class="title col-0"><span class="grouptitle col-0">Professionalism</span></label><label class="title col-1"><span class="value col-1"><input id="18_3_0" type="radio" class="checkRadio"
title="Professionalism - 1 (Very low)" value="515353061" name="REPLY_93770232" disabled="disabled"></span>1 (Very low)</label><label class="title col-2"><span class="value col-2"><input id="18_3_1" type="radio" class="checkRadio"
title="Professionalism - 2" value="515353062" name="REPLY_93770232" disabled="disabled"></span>2</label><label class="title col-3"><span class="value col-3"><input id="18_3_2" type="radio" class="checkRadio"
title="Professionalism - 3" value="515353063" name="REPLY_93770232" disabled="disabled"></span>3</label><label class="title col-4"><span class="value col-4"><input id="18_3_3" type="radio" class="checkRadio"
title="Professionalism - 4" value="515353064" name="REPLY_93770232" disabled="disabled"></span>4</label><label class="title col-5"><span class="value col-5"><input id="18_3_4" type="radio" class="checkRadio"
title="Professionalism - 5 (Very high)" value="515353065" name="REPLY_93770232" disabled="disabled"></span>5 (Very high)</label></div>
<div class="row row-3 even"><label class="title col-0"><span class="grouptitle col-0">Overall rating</span></label><label class="title col-1"><span class="value col-1"><input id="18_4_0" type="radio" class="checkRadio"
title="Overall rating - 1 (Very low)" value="515353066" name="REPLY_93770233" disabled="disabled"></span>1 (Very low)</label><label class="title col-2"><span class="value col-2"><input id="18_4_1" type="radio" class="checkRadio"
title="Overall rating - 2" value="515353067" name="REPLY_93770233" disabled="disabled"></span>2</label><label class="title col-3"><span class="value col-3"><input id="18_4_2" type="radio" class="checkRadio"
title="Overall rating - 3" value="515353068" name="REPLY_93770233" disabled="disabled"></span>3</label><label class="title col-4"><span class="value col-4"><input id="18_4_3" type="radio" class="checkRadio"
title="Overall rating - 4" value="515353069" name="REPLY_93770233" disabled="disabled"></span>4</label><label class="title col-5"><span class="value col-5"><input id="18_4_4" type="radio" class="checkRadio"
title="Overall rating - 5 (Very high)" value="515353070" name="REPLY_93770233" disabled="disabled"></span>5 (Very high)</label></div>
</div>
</div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93770326"></a>
<fieldset id="93770326">
<legend><label for="19_0"><span class="IEWrap"><b>Any comments specific to Surveyor #1?</b></span></label></legend>
<div class="fieldset-content openanswerlong"><textarea id="19_0" wrap="yes" rows="6" name="REPLY_93770326" cols="50" maxlength="4000"></textarea><span class="text-feedback">0/4000</span></div>
</fieldset>
<a style="font-size:1px;padding:0;margin:0;" name="93770746"></a>
<fieldset id="93770746">
<legend><span class="IEWrap"><b>Do you want to evaluate another Surveyor?</b></span></legend>
<div class="fieldset-content singlevert">
<table cellpadding="0" cellspacing="4" border="0" class="vertical" role="presentation">
<tbody>
<tr>
<td>
<div class="singlevert-item-wrapper even"><input id="20_515356657" title="Yes" type="radio" value="515356657" name="REPLY_93770746"><label for="20_515356657" class="verti">Yes</label></div>
</td>
</tr>
<tr>
<td>
<div class="singlevert-item-wrapper"><input id="20_515356658" title="No, I have evaluated all Surveyors" type="radio" value="515356658" name="REPLY_93770746"><label for="20_515356658" class="verti">No, I have evaluated all
Surveyors</label></div>
</td>
</tr>
</tbody>
</table>
</div>
</fieldset>
</div>
</div>
<div class="NextBackSendButtons"><!--ButtonRoutingLink => First page in routing when using link(or preview)-->
<input type="Button" value="Next" name="B1" onclick="submitOnce()" class="rightButton">
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</div>
<div class="completedstatuscontainer">
<div id="statusbarcontainer">
<span class="progress-text">10 % completed</span>
<div id="completedstatus" class="progress progress-striped progress-active">
<div class="bar" style="width: 10%;"><span class="hide">Progress: </span></div>
</div>
</div>
</div>
</form>Text Content
CUSTOMER SATISFACTION SURVEY - HEALTHCARE ACCREDITATION PROGRAM -------------------------------------------------------------------------------- Please provide some information about your company: * The name of the Hospital * The name of the site/branch * Your business email * Your name -------------------------------------------------------------------------------- SECTION 1 – OVERALL SATISFACTION [Dear Customer, please provide your feedback on your overall experience with DNV.] * How Satisfied are you with the quality of services provided by DNV? Very dissatisfied Dissatisfied Neutral Satisfied Very Satisfied * How likely are you to recommend DNV to a colleague and/or business partner? (0-Not at all likely, 10-Extremely Likely). 0 1 2 3 4 5 6 7 8 9 10 * How likely is it that you would prefer DNV over alternative suppliers in the future? Not at all likely Unlikely Neutral Likely Extremely likely What would you suggest we improve regarding the accreditation survey process? 0/4000 -------------------------------------------------------------------------------- SECTION 2 – SERVICE DELIVERY The survey team was prepared upon arrival at our facility. Completely Disagree Disagree Neutral Agree Completely Agree The survey team related well to our staff at all levels of the organization. Completely Disagree Disagree Neutral Agree Completely Agree The survey team’s opening session was clear and informative about the survey goals and expectations. Completely Disagree Disagree Neutral Agree Completely Agree The survey team members were respectful and minimized disruptions in patient care. Completely Disagree Disagree Neutral Agree Completely Agree The DNV team made themselves available to address any questions or concerns throughout the survey process. Completely Disagree Disagree Neutral Agree Completely Agree The clinician provided a thorough review of our patient care processes as outlined in the agenda. Completely Disagree Disagree Neutral Agree Completely Agree The Quality Management session was helpful in understanding the value of quality metrics and how data is driving improved outcomes. Completely Disagree Disagree Neutral Agree Completely Agree The Physical Environment document review and building tours were helpful in understanding the applicable requirements and to maintain a safe and effective physical space for patient care to thrive. Completely Disagree Disagree Neutral Agree Completely Agree Enough time was given for you to tell us about your processes and how you meet applicable requirements. Completely Disagree Disagree Neutral Agree Completely Agree Implementing the ISO 9001 standard has helped us minimize our variances, helped us improve patient care, and continues to positively impact our Quality Management system. (Select N/A if ISO 9001 is not yet applicable to your organization). Completely Disagree Disagree Neutral Agree Completely Agree N/A The survey team’s end-of-survey closing session was clearly communicated so that the organization understood all identified non-conformities and why they did not meet applicable requirements. Completely Disagree Disagree Neutral Agree Completely Agree -------------------------------------------------------------------------------- SECTION 3 – SURVEYOR’S SKILLS Please enter the name of Surveyor #1: 0/255 On a scale of 1-5 (1 completely dissatisfied – 5 completely satisfied) please rate each of the following: 1 (Very low) 2 3 4 5 (Very high) Communication skills Demeanour Professionalism Overall rating Communication skills1 (Very low)2345 (Very high) Demeanour1 (Very low)2345 (Very high) Professionalism1 (Very low)2345 (Very high) Overall rating1 (Very low)2345 (Very high) Any comments specific to Surveyor #1? 0/4000 Do you want to evaluate another Surveyor? Yes No, I have evaluated all Surveyors 10 % completed Progress: Created with Questback Experience Management Free trial - create a survey with Questback