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

Data Collection Toolkit

Falls-Prevention-Data-Collection-Toolkit_2019

.pptx

Download

English

Falls-Prevention-Forms-English

.zip

Download

Cambodian

Falls-Prevention-Forms-Cambodian

.zip

Download

Chinese

Falls-Prevention-Forms-Chinese

.zip

Download

French

Falls-Prevention-Forms-French

.zip

Download

Hmong

Falls-Prevention-Forms-Hmong

.zip

Download

Italian

Falls-Prevention-Forms-Italian

.zip

Download

Korean

Falls-Prevention-Forms-Korean

.zip

Download

Polish

Falls-Prevention-Forms-Polish

.zip

Download

Russian

Falls-Prevention-Forms-Russian

.zip

Download

Spanish

Falls-Prevention-Forms-Spanish

.zip

Download

Vietnamese

Falls-Prevention-Forms-Vietnamese

.zip

Download