Fillable Take Steps to Prevent Falls (CITY OF FOREST GROVE)

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Take Steps to Prevent Falls (CITY OF FOREST GROVE)

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Take Care of Yourself
Yes No
Do you take medication?
Have your doctor or pharmacist review all of your medications,
including over-the-counter medicine. Some medications can affect
your balance and coordination.
Yes No
Have you had your eyes checked recently?
See an eye doctor once a year. Poor vision can increase your
chance of falling. Clean eyeglasses regularly.
Yes No
Do you exercise regularly?
Regular exercise builds strength and improves balance and
coordination. Ask your doctor or other medical care provider about
the best exercise for you.
Keep Pathways Clear
Yes No
Are there tripping hazards on the oor, in walking areas, or on
stairways in your home?
Keep walking areas clear of loose rugs, cords, shoes, clothing,
books, magazines, paper, and other clutter. Always keep objects off
the stairs.
Yes No
Do you wipe up spilled liquids right away?
Spills make your oors slippery; even a few drops of liquid or
grease can be a slipping hazard.
Yes No
In winter, are sidewalks, outdoor steps, and walkways clear of
ice, snow or standing water?
Keep the walkways clear. If needed, ask for help with snow and ice
removal.
Yes No
Do you have pets or small children in your home?
Watch where you step to make sure you don’t trip or fall.
Take Steps to Prevent Falls
Checklist
HOME SAFETY
IS UP TO YOU!
Slow Down
Yes No
Do you rush to answer the phone or doorbell?
Take your time. Being rushed or distracted increases your chances
of falling. Get out of chairs slowly.
Yes No
Do you have electrical cords placed under rugs?
Don’t place electrical cords under rugs or through doorways.
Unplug them and move them to a safer location.
Yes No
Do you get out of bed too quickly?
Sit up a moment before getting out of bed. When standing, get your
balance before walking.
Lighting
Yes No
Do all rooms have light switches reachable from the
doorway?
If not, ask for help installing new light switches.
Yes No
Do you have night lights along the path between your bedroom
and the bathroom?
Use night lights in walkways. They are the easiest and least
expensive way to light the way.
Yes No
Do you turn on the lights before you use the stairs?
Never climb stairs in the dark. Stairways should be well lit from top
to bottom. If needed, ask for help installing new lights and switches.
Rugs & Non-Slip Mats
Yes No
Do your rugs have non-skid backing?
Use rugs that have a rubber or non-skid backing. Smooth out all
wrinkles and folds in your rugs and carpets.
Yes No
Is your carpeting wrinkled, torn, or worn?
If so, ask for help getting it repaired or replaced.
Yes No
Are there non-slip bath mats in bathtubs and showers?
Use non-slip mats in the bathtub and on shower oors to prevent
slips and falls.
Handrails & Grab Bars
Yes No
Do you have grab bars in tubs, showers, and near all toilets?
Install grab bars by the bathtub, shower, and toilet. Never use a
towel rack or shower rod for support.
Yes No
Are there sturdy handrails on both sides of the stairs?
If not, ask for help securing loose handrails to the wall, or installing
new handrails along the full length of both sides of the stairs.
Shoes & Mobility Devices
Yes No
Do you wear high heels, loose shoes, or slippers?
Wear sturdy, well-tted, low-heeled shoes with non-slip soles. These
are safer than high heels, thick-soled athletic shoes, slippers, or
stocking feet.
Yes No
Do you use a mobility device (cane, walker, or wheelchair)?
Make sure your mobility device has been tted for you. Consult your
medical care provider.
Oregon State Police • Ofce of State Fire Marshal
4760 Portland Road NE • Salem, OR 97305-1760
503-934-8266 • osfm.ce@state.or.us
For life threatening emergencies, call 9-1-1
For information about fall prevention and safety, contact your local medical
provider or visit: www.oregon.gov/OSP/SFM/CommEd_SR_Program.shtml.
Having a medical alert system can ensure
that help arrives more quickly.
Post your medical history and medication list
on your refrigerator or other visible area.
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Take Steps to Prevent Falls (CITY OF FOREST GROVE)

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Completed 13 February 2021

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