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01623 404721

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KCH Psychological Safety Team Assessment Questionnaire

Please complete the below survey. This is a confidential questionnaire, please answer honestly.

1 = Strongly Agree 7 = Strongly Disagree

Kings College Hospital Team Survey Form

Your Manager’s Name

Date

1. If you make a mistake on this team, it is often held against you.

1

2

3

4

5

6

7

2. Members of this team are able to bring up problems and tough issues.

1

2

3

4

5

6

7

3. People on this team sometimes reject others for being different.

1

2

3

4

5

6

7

4. It is safe to take a risk on this team. (Risk = an emotional / personal risk, not a risk that would compromise patient safety)

1

2

3

4

5

6

7

5. It is difficult to ask other members of this team for help.

1

2

3

4

5

6

7

6. No one on this team would deliberately act in a way that undermines my efforts.

1

2

3

4

5

6

7

7. Working with members of this team, my unique skills and talents are valued and utilized.

1

2

3

4

5

6

7

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