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Fall investigation form 2026

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  1. Click ‘Get Form’ to open the fall investigation form in the editor.
  2. Begin by entering the resident's name, room number, and social security number at the top of the form. This information is crucial for identifying the individual involved.
  3. Fill in the date and time of the incident, along with your name as the staff completing the report and the date of report completion.
  4. Answer whether the resident has a history of falls by selecting 'Yes' or 'No.' If 'Yes,' list all relevant incidents from the past 12 months, including dates and times.
  5. Proceed to assess if the resident was identified as high risk for falls on their care plan. Check any patterns observed during falls in section three.
  6. In section four, identify contributing factors by checking all applicable boxes such as wet floors or improper footwear.
  7. Continue filling out sections regarding injury level, witness accounts, and detailed descriptions of the incident. Ensure all fields are completed accurately for thorough documentation.

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Related links

Checklist Fall Risk Factors

Problems with heart rate and/or arrhythmia. Yes. No. Cognitive impairment. Yes. No. Incontinence. Yes. No. Depression. Yes.Read more

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Slip, Trip, and Fall Prevention

Appendix B. Fall Hazard Investigation Guide. The following guide should be used to investigate falls that occur on the same-level walking-working surface.Read more

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This is an OSHA ARCHIVE document, and may no longer

Nov 29, 2011 Executive Summary. This instruction provides guidance to Occupational Safety and Health Administration (OSHA).Read more

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