Objective: This study aimed to understand the perception of patient safety and the reporting system in public in China, and make further recommendations for the optimization of the reporting system of patient safety. Methods: The following data were collected through an online questionnaire from medical staffs and patients: recognition of patient safety, comments on patient participation, comments on spontaneous reports, attitudes toward the principles of spontaneous reports, and willingness to participate. This information was presented with frequency and percentage with 95% confidence intervals (CIs). Spearman rank correlation was used to evaluate the association of those data. Results: A total of 27,493 valid questionnaires were collected in this study. The participants who knew patient safety very well, regarded patients as an essential part to enhance patient safety, viewed spontaneous reports helpful, agreed on the 3 principles of voluntariness, anonymity, and nonpunishment of the reporter, and were willing to participate in reporting were accounted for 39.2% (95% CI, 38.6%–39.8%), 31.2% (95% CI, 30.7%–31.8%), 25.2% (95% CI, 24.7%–25.7%), 24.0% (95% CI, 23.5%–24.5%), and 19.9% (95% CI, 19.4%–20.4%), respectively. A moderate positive correlation was observed between comments on spontaneous reports and attitudes toward the principles of spontaneous reports (medical staffs versus patients, r _s = 0.452 versus r _s = 0.439; both, P < 0.01), as well as comments on patient participation and comments on spontaneous reports (medical staffs versus patients, r _s = 0.410 versus r _s = 0.460; both, P < 0.01). Conclusions: The awareness of patient safety may influence the choices of the other questions subsequently and may affect their voluntariness for safety reports ultimately. Pertinent measures, such as publicity of the relevant concept, simplification of the reporting procedures, and promotion of incentive mechanisms, should be adopted to promote the optimization of the reporting system.