Key Takeaways
Organizations funded by the Administration for Community Living are required to collect data on evidence-based falls prevention programs.
The forms have been translated into the most common languages used for workshop implementation. Contact us if you don't see the language you need.
Download the forms by language below. Each file is a zip folder with the following forms:
- Host Organization Information Form
- Program Information Cover Sheet
- Falls Prevention Program Group Leader/Coach Script
- Attendance Log
- Participant Information Form (Pre-Survey)
- Post Session Survey
- Optional Questions for Participant Pre- and Post- Surveys
Falls-Prevention-Data-Collection-Toolkit_2019
Falls Prevention Forms
| Language (Format) | Download |
| English (Word Documents) | Link |
| English (Fillable PDFs) | Link |
| Spanish (Word Documents) | Link |
| Spanish (Fillable PDFs) | Link |
| Arabic (Word Documents) | Link |
| Armenian (Word Documents) | Link |
| Gujarati (Word Documents) | Link |
| Hindi (Word Documents) | Link |
| Korean (Word Documents) | Link |
| Mandarin (Word Documents) | Link |
| Russian (Word Documents) | Link |
| Urdu (Word Documents) | Link |
View Chronic Disease Self-Management Education Data Collection Tools.
