Welcome to the Australian Nappy Network's survey on Cloth in Hospitals.

We are developing a database for parents to locate hospitals, particularly maternity and pediatric hospitals, which use the nappies parents themselves want used on their children.

Whether you are a parent or service provider, we would appreciate if you could complete as many details as possible.

This quick survey should take less than 5 minutes to complete. You might like to grab the contact details of the hospital before you start.

All questions marked with an * asterisk are mandatory questions and must be completed for the survey to be submitted!

1. What is the name of the hospital? Required Question

2. What is the street address of the hospital? Required Question

3. In which State is the hospital? Required Question

4. What is the postcode of the hospital? Required Question

5. What is the hospital's telephone number?

6. If the hospital has a website, please provide the address:

7. If the hospital has an email address, please provide it here:

8. Who operates the hospital?

	Private
	Government
	I don't know
	Other

9. For which section/s of the hospital are your responses relevant?
(Please complete a new survey if the policies regarding nappy use are different for different sections of the hospital. If the policy is consistent for all sections, you may complete only one survey. Mark here the section for which this survey is completed). Required Question

	Maternity/Neo-natal
	Pediatric
	Both Maternity/Neo-natal AND Pediatric
	Other

10. What type of nappies does the hospital use?
(tick all that apply) Required Question

11. Does the hospital make any exceptions to their policy?

12. How willing is the hospital to accommodate parents' wishes regarding what nappies to use on children?

13. Do you have any comments about the hospital's policy on nappies?

14. What is your relationship to the hospital? Required Question

15. Please complete your contact details for verification purposes. These details will not be published. If you choose not to enter these details, your survey responses may not be used.

First Name Required Question

Last Name

Street Address

City

State

Postal Code

Email Address Required Question

Phone Number

16. What is today's date? Required Question

17. Do you have any other comments?

18. Would you like to receive more information about the ANN? Required Question

	Yes
	No

19. Would you like to receive email notification when the database becomes publicly available? Required Question

	Yes
	No

	the hospital provides and launders cloth nappies and covers
	the hospital provides and launders cloth nappies (parents to provide and launder covers)
	the hospital provides disposable nappies
	the hospital provides only disposable nappies
	the hospital employs a nappy wash service to provide and launder their nappies
	parents can supply their own cloth nappies (parents to arrange laundering privately)
	parents can supply their own cloth nappies and covers (hospital can arrange laundering)
	parents can supply their own disposable nappies
	the hospital will not use (or allow the use of) cloth nappies
	the hospital will not use (or allow the use of) disposable nappies

	Owner/Manager
	Employee
	Patient (current)
	Patient (past - please state year)
	Other - please describe

Not at all		Somewhat		Very

ANN Nappies in Hospitals Survey