Which of the following is at the base of the quality pyramid? 

A. Procedures B. Health C. Safety D. Environment

 D.

6 answers

http://www.google.com/search?q=quality+pyramid&biw=1830&bih=927&tbm=isch&tbo=u&source=univ&sa=X&ei=emZOVLinJYy0yASdoYHoDA&sqi=2&ved=0CB0QsAQ
Safe environment, yes.

http://www.schoolsoutwashington.org/UserFiles/Image/ypqi%20pyramid1.bmp
So the answer is C & not D
Did you look at the linked graphic? When you search for "quality pyramid" on Google, this is what you get:
http://www.google.com/search?q=quality+pyramid&oq=quality+pyramid&aqs=chrome..69i57j0l5.8509j0j7&sourceid=chrome&es_sm=119&ie=UTF-8

Choose your image. Which one works with what your text says?
It's A.
Staff members familiar with a quality pyramid concept and who use it in their planning are more likely to emphasize _______ as the base of the pyramid.