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 Guidance

Falls-Prevention-Data-Collection-Toolkit_2019

.pptx

Download

English (Word Documents)

Falls-Prevention-Forms-English-7-13-21

.zip

Download

English (Fillable PDFs)

Falls-Prevention-Forms-Fillable-PDFs

.zip

Download

Spanish (Word Documents)

Falls-Prevention-Forms-Spanish-8

.25

Download

Mandarin (Word Documents)

Falls-Prevention-Forms-Mandarin%20Chinese-9

.16

Download