To establish a cross-cultural adaptation of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey and to use this instrument to evaluate the impact of a safety intervention. Cross-cultural adaptation and before-and-after evaluation study. 5 ICU. Medical residents, attending physicians, and nurses at those ICU. Adaptation of the SCORE survey to Spanish culture. The adapted survey was used to assess all safety-culture-related domains before and one-year after implementing the use of a safety tool, Real-Time Random Safety Audits (in Spanish: Análisis Aleatorios de Seguridad en Tiempo Real, AASTRE). Adaptabiliy of the Spanish version of SCORE survey in the ICU setting and evaluation of the effect of AASTRE on their domains. The cross-cultural adaptation was adequate. Post-AASTRE survey scores mean (standard deviation, SD) were significantly better in the domains learning environment 50.55 (SD 20.62) vs 60.76 (SD 23.66), p<.0001, perception of local leadership 47.98 (SD 23.57) vs 62.82 (SD 27.46), p<.0001, teamwork climate 51.19 (SD 18.55) vs 55.89 (SD 20.25), p=.031, safety climate 45.07 (SD 17.60) vs 50.36 (SD 19.65), p=.01, participation decision making 3 (SD 0.82) vs 3.65 (SD 0.87), p<.0001 and advancement in the organization 3.21 (SD 0.77) vs 4.04 (SD 0.77), p<.0001. However, post-AASTRE scores were significantly worse in the domains workload and burnout climate. The cross-cultural adaptation of the SCORE survey into Spanish is a useful tool for ICUs. The application of the AASTRE is associated with improvements in six SCORE domains, including the safety climate.