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Safety First: A Detailed Fall Prevention Program Checklist

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Safety First: A Detailed Fall Prevention Program Checklist

Fall Prevention Program Checklist

Needs Assessment, Target Audience & Available Resources

Are fall prevention activities feasible and will best serve the needs of the elderly?
Does the program fit our organization?
Does the program complement other programs already being offered?
Is the program appropriate for our target older adult population?
Are older adults in the nursing home interested in the program?
Is safe, reliable, and low-cost transportation to and from the program available?
Do we have personnel with the expertise to conduct the program or is there a system in place to train program instructors?
Are the costs and resources needed within our budget?

Program Characteristics

Does the program require specially trained instructors?
Will the program provide education about fall prevention?
Does the program promote falls self-efficacy (confidence to prevent falls) among the participants?
Are there opportunities for social interaction among the participants? (Such opportunities contribute to program retention and sustainability.)
Does the program address modifiable risk factors (e.g., exercises to improve lower body strength and balance)?
Can the program be tailored to meet the differing abilities of the participants?
Are exercises progressive (get more challenging over time)? This is a key component of an effective fall prevention exercise program.)
Can your facility provide the amount of time needed to provide the recommended intervention dose (e.g. for a total of 50 hours for a Tai Chi program)?
Does the program include strategies to reduce the possibility of activity related injuries?


Are there program materials and training manuals available?
Can the program be implemented with fidelity in your setting?
Does the program offer strategies for linking participants and the program itself with healthcare providers as needed?


Does the program include methods for maintaining and monitoring fidelity and program quality over time?
Does the program include easy-to-administer pre- and post-functional tests, such as the Timed Up and Go (TUG) test, to document improvements in participants’ functional abilities?


Additional Recommendation
Nursing Home Supervisor Name & Signature
Worker Name & Signature
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