ElderlyDaily original · Health logs & diaries
Fall Prevention Planner for Seniors and Caregivers
The CDC's fall prevention advice as pages you fill in: a fall log your doctor can use, the 12-question risk checklist, a room-by-room home check and an 8-week tracker.
- The CDC's 12-question Stay Independent checklist
- A fall and near-miss log (12 records)
- A room-by-room home safety check with fixes
- An 8-week strength and balance tracker
One-time purchaseInstant download41-page fillable PDF · US Letter + A4
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More than 1 in 4 older adults fall each year, and less than half tell their doctor, according to the CDC. This planner helps you write down what happened, check the home room by room, and work on strength and balance, all in one large-print file.
It is built on the CDC's STEADI materials for older adults and families, with guidance from the NHS and the National Council on Aging. Take the 12-question checklist at the start and again at week 8.
What's inside
Every section, page by page
Know your risk
- The CDC's Stay Independent checklist: 12 questions with points, now and at week 8
- A medicine review, My Medicines and Medicine Changes
- Eyes, feet and shoes
If a fall happens
- Fall and near-miss log, 12 records: where, when, what happened, any injury, how you got up and what you changed
- How to get up safely, what to do if you can't, and when to call 911
- My Fall Plan, a dizziness log and the CDC's steps for getting up slowly
Home check
- The CDC home safety checklist, room by room
- A suggested fix for each problem
- A home fix plan
Strength & balance
- The CDC chair-rise exercise
- An 8-week activity tracker
- How to find an evidence-based program near you
Caregivers & doctor visits
- Pages for family caregivers and for after a hospital stay
- Questions to ask
- 3 doctor-visit pages and a review page
Preview
A closer look
Images from the product listing.
Free or full?
Start free, or get the full version
We also have a free printable on this topic. Here is what each one gives you.
Free on ElderlyDaily
Free fall risk checklist
- The CDC’s 12-question fall risk checklist
- A log for every fall and near miss
- What to do if you fall
The full version adds
Fall Prevention Planner
- A room-by-room home check, with a fix for each problem
- A dizziness log and a medicine review
- The CDC chair-rise exercise and an 8-week tracker
- 3 doctor-visit pages and pages for family caregivers
Who it’s for
- Older adults who have fallen, nearly fallen, or feel unsteady
- Family caregivers worried about a parent falling at home
- Anyone getting ready for a doctor's visit about falls, dizziness or balance
How to use it
- 1Take the 12-question checklist and note your score.
- 2Walk through the home check room by room and list the fixes.
- 3Log every fall or near miss, and bring the log to the doctor.
- 4With your doctor's OK, do the chair-rise exercise and track activity for 8 weeks.
- 5Retake the checklist at week 8 and compare.
Instant download
Fall Prevention Planner
Not ready yet? Get 7 free pages from the Fall Prevention Planner
7 print-only pages from the full version: a fall plan, getting up slowly, a dizziness log, a room-by-room home check, the chair-rise exercise, an activity tracker and a doctor visit page. US Letter and A4. We’ll email them to you, plus a few tips after that. Unsubscribe anytime.
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Fall Prevention Planner is included in each of these.
Who makes these
Every ElderlyDaily printable is designed by SK Kutubuddin, who founded ElderlyDaily as a family caregiver. Where a page uses official guidance, such as the CDC’s fall-risk questions or the American Heart Association’s blood pressure categories, it names the source. About ElderlyDaily · Editorial policy
Questions
Good to know
Which fall-risk checklist does it use?
The CDC's Stay Independent checklist from its STEADI materials: 12 questions with points. You take it at the start and again at week 8.
Will it help me talk to the doctor?
Yes, that is what it is built for: a fall log your doctor can use, questions to ask and three doctor-visit pages. Talk to your doctor before starting a new exercise program or changing a medicine.
Can I fill it in on my phone?
Yes. Fill it in on a computer, or on a phone or tablet with the free Adobe Acrobat Reader app. Or print it and use a pen.
Which paper sizes are included?
Both US Letter and A4.
Is this medical advice?
No. It is a planner for recording information to share with your doctor or physical therapist, and it does not diagnose any condition.
Can I get a refund?
Because it is an instant digital download, all sales are final. If a file will not open or download, email sk@elderlydaily.com and we will make it right.
Free on ElderlyDaily
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A planner for recording information to share with your doctor or physical therapist; not medical advice. Built on the CDC's STEADI materials, the NHS and the National Council on Aging.
