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Survey Submission

This page is only for Care Extenders volunteering in the following UCLA Medical Center, Santa Monica departments: 

  • Critical Care Unit (CCU) 
  • Emergency Room (ER)
  • Medical Surgical (MED SURG)
  • Oncology (ONCO)
  • Orthopaedics (ORTHO)
  • Santa Monica Pediatrics (SMH-PEDS) 

Electronic Support Services Survey Submission - Click the "Electronic Support Services Survey Submission" link to your left to submit your Support Services Quality Control Survey online for all departments listed above except the Emergency Room.

Emergency Room Electronic Support Services Survey Submission - Click the link to your left to submit your Support Services Quality Control Survey for Emergency Room only online.

Survey Submission Rules You may wish to download the survey submission rules for a refresher if you have forgotten the survey submission process.

You must submit a survey for every shift you volunteer. If you were unable to survey a patient, you must still submit a survey but click the option "no - there were no patients available for survey" before submitting. Please contact the Administrative Coordinator (ce.adcoordinator@gmail.com) if you have any further questions.

The Support Services Quality Control Survey is an important tool to report information for UCLA Medical Center, Santa Monica. The information is used on a weekly basis to address problem areas in the hospital's support services, such as environmental services, nutrition, transport, etc. Your help with filling out these surveys during every one of your volunteering shifts in the department is invaluable to the hospital and the level of care it provides to its patients. You will be able to find blank copies of these Support Services Quality Control Surveys at the Arizona entrance of the Santa Monica Hospital. There is a grey box fixed to the wall approxfimately at eye level across the hall from the sign in computer. Please take one of these surveys every time you volunteer in the Critical Care Unit, Emergency Room, Medical Surgical, Oncology, Orthopaedics, or Pediatrics at Santa Monica. During your shift, kindly ask the charge nurse which patients would be the best to interview. Kindly approach the patient when it is convenient for them (not undergoing a procedure or speaking with medical staff) and practice CICARE:

  • Connect with the patient
  • Introduce yourself and your role
  • Communicate to them that you would like to ask them some questions regarding the support services
  • Ask if they have any questions or concerns and for their permission to do the survey
  • Respond to their questions/concerns
  • Exit courteously

Please ask them if they have done the survey recently; if they have, thank them for their time and move onto a patient who has not done the survey recently. This will help us get feedback from more patients.