Department of Health Framework for Learning and Improvement from Patient Safety Incidents Consultation Questionnaire

1. Are you responding:

(Required) as an individual? (Please complete questions 2-4) on behalf of an organisation? (Please complete question 5)

2. Are you a child/young person (under the age of 18)?

Yes No

3. Do you have lived experience, or close hand experience, of the Serious Adverse Incident process under the current Procedure for the Reporting and Follow up of Serious Adverse Incidents 2016?

Yes No Prefer not to say

4. If yes, please confirm if you experienced the current procedure as:

a Patient a Family Member a Carer Other Prefer not to say

If other, please specify:

5. If you are responding on behalf of an organisation, please provide your name and position, the name and address of the organisation and an email address.

Name

Job Title

Organisation

Address

Email address

About you