Chesapeake Bay Society of PeriAnesthesia Nurses

Assessment Form

 

Hospital: _________________________________    Unit: ________________________

 

Free Standing: ____ Yes  ____ No         Position: ________________________________

 

Number of Beds in Unit: ______________      Number of ORS: ____________________

 

Number of years in nursing: ____________    Number of years in PACU: ____________

 

What certifications do you hold?__________________

 

Do you get any reimbursement for attending education seminars?  __________________

 

What areas of interest would you like to see presented at a seminar? _________________

 

 

Would you attend a two-day seminar? _________________________________________

 

Do you visit the CBSPAN web site?  _________________________________________

 

Would you like to see anything else on the website? _____________________________

 

 

What would you like to see in a newsletter? ____________________________________

 

 

How can we as Board members help you? _____________________________________