First name

Last name

Email address

Zip code

Questionnaire

1. Does your facility sterilize equipment with glutaraldehyde?

yes
no
I don't know

2. Does your facility sterilize equipment with ethylene oxide?

yes
no
I don't know

3. Does your facility use mercury thermometers?

yes
no
I don't know

4. Does your facility use mercury sphygmomanometers (blood pressure monitors)?

yes
no
I don't know

5. Have you ever helped clean up a mercury spill at work?

yes
no
I don't know

6. Have you ever been involved in any other hazardous chemical spill at work?

yes
no
I don't know

6b. If so, what chemical(s) were spilled?

7. Do you smell chemical fumes in your work environment regularly? (This includes fumes from housekeeping chemicals, sterilizing agents like glutaraldehyde and ethylene oxide, and anesthetic gases.)

yes
no
I don't know

7b. If so, which chemicals do you smell most frequently?

8. If you prepare medications, do you do so under a hood or other ventilated area?

yes
no, I don't use a hood or a ventilation
no, I don't prepare medications

9. Does your facility intentionally purchase "green" (less hazardous) housekeeping chemicals?

yes
no
I don't know

10. Are Latex gloves the standard in your facility?

yes
no
I don't know

Your story (optional)

Nominate a Nurse (optional)