• Hospital Fall Prevention Checklist Form

    Complete this checklist to assess fall risk factors and ensure all prevention measures are in place for hospitalized patients.
  • Patient Orientation to Environment Completed*
  • Mobility Assessment Performed*
  • Medication Review for Fall Risk Medications*
  • Use of Assistive Devices*
  • Footwear Assessment*
  • Environmental Hazards Checked*
  • Call Bell Within Reach*
  • Bed/Chair Alarms in Use if Indicated*
  • Side Rails Position*
  • Patient and Family Education Provided*
  • Should be Empty:
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