The AHFSA Surveyor Registry
The AHFSA Surveyor Registry has been created for retired surveyors who are interested in continuing in the surveyor field post retirement. The intent of this registry is to assist State Agencies by supplementing the state workforce and to meet the mission and priorities document expectations. Information collected is not shared outside of AHFSA. Surveyors who subscribe to the registry understand that their information will be accessible to all state agencies who access the registry.
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Surveyor Full Name
Who was your State Agency employer?
Dates of service?
Name and contact email of former supervisor?
Do you give permission to contact your former supervisor?
What provider types are you interested in surveying
Skilled Nursing Facility - must be SMQT qualified
Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
Home Health Agency
Ambulatory Surgery Center (ASC)
End Stage Renal Dialysis (ESRD)
Rural Health Clinic
Psychiatric Residential Treatment Facility (PRTF)
Portable X-Ray facility
Community Mental Health Center (CMHC)
PPS Exempt Psychiatric Unit
PPS Exempt Rehabilitation Unit
Outpatient Physical Therapy/Speech Therapy
Comprehensive Outpatient Rehabilitation Facility (CORF)
Federally Qualified Health Center (FQHC)
Life Safety Surveyors
If you listed "other" as a facility type, please include that facility type here.
What is your date of availability?
What state(s) are you interested in surveying?
List your professional credentials.
Include any other information you feel is valuable in consideration of your availability to survey.
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