Fall Risk Assessment | Home Safety & Fall Prevention Checklist | Fillable & Printable PDF
Falls can happen for many reasons, and sometimes the risks aren't obvious until you stop and look for them.
The Fall Risk Assessment is a simple, practical tool designed to help families identify common factors that may contribute to falls and take a closer look at safety in everyday life.
Use it to work through potential concerns, make notes about anything you've noticed, and identify areas you may want to discuss with a healthcare professional or address at home.
I created this resource as a nurse to give families an easy way to step back and look at the bigger picture. It isn't about predicting whether someone will fall. It's about noticing potential risks before they become bigger problems.
How to Use It
Work through the checklist based on what you currently know and observe. Use the notes section to record concerns, changes you've noticed, questions you want to ask, or areas that may need attention.
Revisit the assessment when circumstances change, such as after an illness, hospitalization, medication change, new mobility difficulty, or a fall.
What You'll Receive
- Fall risk assessment and safety checklist
- Space for notes and observations
- Fillable PDF for completing digitally
- Printable for handwritten use
- Instant digital download
Please Note
This resource is intended for education and organization only. It is not a clinical fall-risk screening tool, diagnosis, medical assessment, or substitute for evaluation and recommendations from a qualified healthcare professional.
If someone has fallen, is experiencing new or worsening balance or mobility problems, or you have concerns about their safety, contact their healthcare professional for individualized guidance.
Copyright & Personal Use
Copyright © 2026 The Peregrine Thread™ Publishing Co. All rights reserved.
For personal use only. This file may not be resold, redistributed, shared, reproduced for commercial use, or uploaded to another website or platform.
Digital product only. No physical item will be mailed.