Optional Questions for Participant Pre- and Post- Surveys (Vietnamese)

Optional survey questions capture data elements that ACL Falls Prevention Grantees may wish to collect over and above the grant-required data elements. These fields are not included on the OMB-approved data collection forms, but you may add them to the Participant Information Form (pre-survey) and Participant Post Program Survey.

Falls Prevention Participant Information Form (Vietnamese)

The purpose of the Participant Information Form is to collect participant demographics, health and disability status, falls history, risk factors, and outcomes information before a participant begins a falls prevention program.

Falls Prevention Grantee Attendance Log (Vietnamese)

This log serves to capture the number of sessions or intervention dose that each Falls Prevention Program participant is completing. This log should be filled in by the person delivering the program (e.g. leader/instructor/coach etc.).

Falls Prevention Group Leader Script (Vietnamese)

The Group Leader Script is designed to be read/paraphrased to program participants prior to their completion of the Participant Information Survey to explain the purpose of the data collection and its voluntary nature.