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Lumiform Mobile audits & inspections
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Overview
Get an overview of the most important features in Lumiform.
Checklist maker
Create custom checklists and use logics to predefine workflows.
Mobile app
Quickly conduct inspections with the easy-to-use inspection app.
Issue resolution
Turn issues into corrective actions by collaborating with team members.
Results, reports & analytics
Share automatically generated reports and get in-depth analytics.
Administration
Easily adapt the Lumiform software to your complex organization structure.
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ISO Audit Templates Fire Safety Templates Gap Analysis Templates Quality Control & Assurance Templates Condition Report Templates Maintenance Plan Templates Due Diligence Templates View all templates
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Checklists
5S Checklist Mystery Shopper Checklist BRC Audit Checklist Incoming Goods Inspection Checklist Safety Observation Report Checklist Restaurant Checklists for Standard Operating Procedure Social Worker Home Visit Checklist View all checklists
Guides
What is 5s in your company? Understanding ISO What Is ISO 9001? What is Kanban? What is Poka Yoke? What is the CE Marking? Child Care Observation Guide View all guides
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A combination of data, facts or timelines with graphics for clear, visual hubs of information.
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Patient Survey Template

This Patient Survey Template based on the HCAHPS Survey helps you to measure the quality of hospital care. Conducted by hospital staff, this digital survey works with conditional logic to hide or present relevant succeeding questions based on earlier answers. This template uses failed items to help you decide which areas in patient care require priority.
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Patient Care Survey
Care from Nurses
Throughout this hospital stay, how often did nurses treat you with kindness and respect?
Throughout this hospital stay, how often did you get help as soon as you needed it, after you pushed the call button?
Throughout this hospital stay, how often did nurses listen attentively to you?
Throughout this hospital stay, how often did nurses explain matters in a way you could understand?
Care from Doctors
Throughout this hospital stay, how often did doctors treat you with kindness and respect?
Throughout this hospital stay, how often did doctors explain matters in a way you could understand?
Throughout this hospital stay, how often did doctors listen attentively to you?
Hospital Environment
Throughout this hospital stay, how often were your room and bathroom held clean?
Throughout this hospital stay, how often was the range around your room quiet at night?
Hospital Experience
Throughout this hospital stay, did you require assistant from nurses or other hospital workers when getting to the bathroom or in using a bedpan?
Throughout this hospital stay, did you feel any pain?
Throughout this hospital stay, were you given any medicine that you never took before?
Leaving the Hospital
Before leaving, do you plan to go straight to your own home, to someone else’s home, or to another health facility?
Overall Rating of the Hospital
On a scale from 0 to 10, (0-the worst hospital possible; 10-the best hospital possible) how would you rate this hospital during your stay?
Would you suggest this hospital to friends and family?
About you
Throughout this hospital stay, were you admitted to here through the emergency room?
In general, how would you rank your overall mental or emotional health?
How would you rate your overall health?
Any comments?
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.

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