Fall and Near-Fall Log
Use it to record where falls happen, what changed, whether injury occurred, who was notified, and what the follow-up action is.
A fall log helps families and clinicians see patterns. A near-fall matters too.
Quick answer
Use it to record where falls happen, what changed, whether injury occurred, who was notified, and what the follow-up action is.
Fall / Near-Fall Entry
| Field | Notes | | --- | --- | | Date and time | | | Fall or near-fall? | | | Location | | | What was happening? | | | Footwear | | | Lighting | | | Assistive device used? | | | Dizziness? | | | Pain? | | | Confusion? | | | Medication change recently? | | | Injury? | | | Hit head? | | | Emergency help called? | | | Clinician notified? | | | Follow-up action | |
Pattern Review
After each month, ask:
| Question | Answer | | --- | --- | | Same time of day? | | | Same location? | | | Same activity? | | | Medication connection? | | | Bathroom connection? | | | Nighttime connection? | | | Footwear or lighting issue? | | | Care plan change needed? | |
Kefiw Tip
Track near-falls as seriously as falls.
A person grabbing the wall three times in one week is not "nothing happened." It is a warning.
Family Script
"We are not tracking falls to blame anyone. We are tracking them to find patterns and prevent the next one."
Red Flags
- Falls repeat.
- Falls are hidden.
- Head injury occurs.
- Confusion follows a fall.
- The person is on blood thinners or has high injury risk.
- Bathroom falls occur.
- Nighttime falls occur.
- Caregiver cannot safely help after a fall.
Reusable Product Asset Uses
This worksheet should eventually support:
- Printable PDF.
- Saveable worksheet.
- Calculator result add-on.
- Care Track step.
- Family summary export.
- Email or share version.
- Bring-this-to-a-tour version when relevant.
- Use-before-a-family-meeting version when relevant.
Professional Review
Recommended reviewer: clinician, physical therapist, occupational therapist
Sources To Verify
Last reviewed: April 29, 2026.
Kefiw Worksheet Disclaimer
Kefiw provides educational care-planning tools, worksheets, and guides. These materials are designed to help families organize information and prepare better questions. They do not replace medical, legal, financial, tax, insurance, employment, benefits, or professional care advice. Care needs, costs, coverage, provider quality, eligibility, and legal requirements vary by person, plan, provider, state, and situation. For urgent medical concerns or immediate danger, call emergency services.
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Frequently asked questions
› How should families use this worksheet? How-to
Use it before a care decision, appointment, tour, provider interview, or family conversation so the discussion starts with facts instead of memory and stress.
› Is this worksheet professional advice? How-to
No. It organizes information and prepares better questions, but medical, legal, financial, tax, insurance, benefits, employment, and care decisions should be confirmed with qualified professionals.
› Should this be printed or saved? How-to
Both can help. A printed copy is useful during tours or family meetings, while a saved copy helps the family update the plan after care needs, costs, or safety risks change.
› How should I use this guide with a Kefiw tool? How-to
Use the guide as the plan and the linked Kefiw tool as the check. Read the steps first, try the move manually, then use the tool to compare outputs, catch edge cases, and decide whether the result actually fits your task.
› What mistake do tool guides help avoid? Troubleshooting
Tool guides help avoid using a utility mechanically without understanding what you are trying to accomplish. Most word, writing, and text utilities are fast, but speed can hide context mistakes. Know whether you are solving a puzzle, cleaning copy, drafting a line, or checking a rule.