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 - 1Mb

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English (Word Documents)

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

.zip - 149Kb

Download

English (Fillable PDFs)

Falls-Prevention-Forms-Fillable-PDFs

.zip - 793Kb

Download

Spanish (Word Documents)

Falls-Prevention-Forms-Spanish-8

.25 - 143Kb

Download

Spanish (Fillable PDFs)

Spanish-Falls-Prevention-Forms-Fillable-PDFs

.zip - 593Kb

Download

 Arabic (Word Documents) 

Falls%20Prevention%20Arabic

.zip - 1Kb

Download

Gujarati (Word Documents)

Falls%20Prevention%20Gujarati

.zip - 1Kb

Download

  Hindi (Word Documents)

Falls%20Prevention%20Hindi

.zip - 1Kb

Download

Mandarin (Word Documents)

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

.16 - 85Kb

Download

Urdu (Word Documents) 

Falls%20Prevention%20Urdu

.zip - 29Kb

Download