Fall risk assessment form 2026

1. Click ‘Get Form’ to open the fall risk assessment form in the editor.
2. Begin by entering the resident's name in the designated field at the top of the form.
3. Check off the appropriate reason for assessment: Initial Assessment, Re-Assessment after a fall, or Periodic Re-Assessment.
4. Proceed to categorize recent fall history by circling reference numbers based on the resident's fall history over the past three months.
5. Evaluate ambulation and continence status, circling reference numbers that reflect whether the resident is ambulatory or chair-bound.
6. Assess mental status and vision, circling relevant reference numbers that indicate alertness and visual capability.
7. Continue through each section, including balance, blood pressure, medications, and predisposing conditions. Circle reference numbers as applicable.
8. Finally, calculate the total score at the end of the form to determine if the resident is 'at risk' for falls.

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