Surveyor Background

1.	Have you passed the Surveyor Minimum Qualifying Test (SMQT) administered by the Centers for Medicare & Medicaid Services (CMS)?
	(Click one)
	1.		Yes
	2.		No

2.	How long have you worked as a state surveyor of nursing homes? Include all time spent as a nursing home surveyor, including time prior to passing the SMQT.
	(Click one)
	1.		Less than 2 years
	2.		2 years to 5 years
	3.		More than 5 years to 10 years
	4.		More than 10 years

3.	Which of the following best describes your professional background?
	(Click one)
	1.		RN
	2.		LPN
	3.		Dietician
	4.		Pharmacist
	5.		Social worker
	6.		Sanitarian
	7.		Other

4.	Do you survey other types of facilities in addition to nursing homes?
	(Click one)
	1.		Yes
	2.		No

5.	What percentage of your time, on average, do you spend engaged in activities related to nursing home health surveys?
	(Click one)
	1.		Less than 25 percent
	2.		From 25 percent to 50 percent
	3.		More than 50 percent

6.	Do you serve as an agency manager or supervisor (such as district office supervisor, training coordinator, survey coordinator, or new surveyor education coordinator)? Please do not consider service as a team leader or training preceptor when answering this question.
	(Click one)
	1.		Yes
	2.		No
	3.		Not sure/No opinion

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Full Report: GAO-10-70

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