Background: The delivery of radiotherapy is complex and demands careful management, high vigilance, and precise coordination of clinical personnel. RTs are at the frontline and are often first to discover or report an error. However, few studies have examined RT patient safety practices. We conducted a national survey to explore the attitudes, training, and experiences of RTs related to safety in radiation oncology. Methods: In 2016, an electronic survey was sent in June and July to a random sample of 1,500 RTs (~10% of licensed RTs in the US). The survey assessed department SC, error reporting, knowledge, and practices. Questions were multiple choice or recorded on a 5-point Likert scale. Results were summarized using descriptive statistics and analyzed using multivariate logistic regression. Results: A total of 702 RTs from 48 states (47% response rate) completed the survey. Respondents represented a broad distribution across practice and geographic settings with varying levels of work experience (see table). Most RTs gave their department a “Patient Safety Grade” of Excellent (61%) or Very Good (32%), especially if they had an Incident Learning System (ILS) (OR: 2.0). Most departments (58%) had an ILS; however 59% of RTs had not reported an event in the previous year. When an error occurred but did not result in patient harm, 39% of RTs said they would report it and 37% said they would not. Bullying was reported among 17% of respondents; 40% reported that burnout, stress, and anxiety negatively impacted their ability to effectively treat patients. RTs reported errors were more likely to occur with longer work days (>8hrs) and poor multidisciplinary communication during handoffs and transitions. Most (62%) reported they could benefit from additional patient safety education and training, indicating significant interest in this topic. Conclusions: The majority of RTs reported excellent SC practices within their treatment facilities. Most facilities had systems in place to report errors. The obstacles identified, the results of this study may inform future educational efforts and safety initiatives directed towards RTs and should help increase awareness of patient SC in radiation oncology.