Preventing Falls in Long-term Care: A Model Recreation Therapy Program

Q.A. Falls risk checklist:

Peer observer please fill out one form for each R.T. program participant.




Program location:______________________________


Program area risk assessment Problems
___ Adequate lighting ___Needs more light
___ No glare on tables, floor, counters ___Glare is present
___ Shelves and cupboards eye height ___ Shelving too high
___ No objects on floor ___ Rugs, cords, objects on floor
___ Furniture is stable with arm rests ___ Unstable furniture or no arm rests
___ Door sills are flush with floor ___ Door sills are raised
___ Empty wheelchairs removed or locked ___ Empty wheelchairs in program area
___ No excessive clutter ___ Clutter on tables, counters, storage areas, halls
___ Stairway well lit with 2 hand rails ___ Stairway needs light or hand rails

Outdoor Program Areas
___No rocks or loose gravel ___Rocks or gravel impede path
___No wet leaves or ice ___Wet leaves/ice on walkways
___Area free of holes, cracked ___Holes in lawn, cracks in pavement
___Walkways and entrances well-lit ___Needs outdoor lighting

___ Properly fitting non-slip footwear ___ Improper or missing footwear
___ Has glasses(clean) and is wearing ___ Glasses missing
___ Steady gait ___ Unsteady gait
___ Able to transfer to chair ___ Unable to safely transfer to chair
___ Alert and aware of environment ___ Confused, wandering
___ Positioned properly for program ___ Slides out of chair
___ Mobility aids accessible ___ Mobility aids out of reach

Completed by:______________________ Date:_____________

Did the participant seem to be at risk for a fall during your observation: