Program tool 22 - page 3 - Active Independent Aging

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Program tool 22. Program log forms

Log form for falls prevention programs

This log form allows you to keep track of falls prevention programs in your legion or centre. Make an entry on this form every time there is an activity or meeting about falls prevention.

Please keep track of the number of participants in your falls prevention program or information session. Also keep a record of the number of times you share falls prevention information with your members as a group or one on one.

Falls prevention topic/program	Date and time	Number of participants	Comments

Active Independent Aging was a joint venture between the University of Ottawa and the Public Health and Long-term Care Branch, City Of Ottawa. For more information please visit our website at: www.falls-chutes.com. Funding provided by Health Canada/Veterans Affairs Canada Falls Prevention Initiative. The views expressed herein do not necessarily represent the official policies of Health Canada, Veterans Affairs Canada, the University of Ottawa and the Public Health and Long-term Care Branch, City Of Ottawa. The information in this handout is current as of 2004.

Program tool 22 - page 2

Program tool 22 - page 4

Last modified May 7, 2004