Organizations funded by the Administration for Community Living are required to collect data on evidence-based falls prevention programs.

Please find the necessary data paperwork below, and please reach out to fallsfree@Stonybrookmedicine.edu with any questions.

1. Host/Implementation Organization Information Form 

2. Program Information Cover Sheet 

3. Participant Information Form (Pre-Survey) 

4. Post-Survey

A Matter of Balance:

A Matter of Balance – Attendance Sheet

A Matter of Balance – Data Collection Tips 

Tai Chi for Arthritis and Falls Prevention:

Tai Chi for Arthritis – Attendance Sheet

Tai Chi for Arthritis – Data Collection Tips

Stepping On:

Stepping On – Attendance Sheet

Stepping On – Data Collection Tips

Otago Exercise Program:

Otago Exercise Program (Group Class) – Attendance Sheet 

Otago Exercise Program – assessment tracking (Session 0)

Otago Exercise Program – Data Collection Tips for Group Classes

*For 1:1 Otago Exercise Program documents please reach out to fallsfree@stonybrookmedicine.edu 

 

For copies in languages other than English please visit NCOA’s Website.