Get Fall Investigation Worksheet

The Fall Investigation Worksheet is an essential tool for documenting incidents related to resident falls. By accurately and promptly completing this worksheet, you can help identify contributing factors and improve safety measures within the care environment.

Follow the steps to complete the Fall Investigation Worksheet online effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the Resident Name, Date of Fall, and Time of Fall in the designated fields.
3. In the first section, ask the resident about their actions prior to the fall and select the most appropriate option from the checklist provided.
4. Describe the position of the resident following the fall. You may draw a picture if it is easier to illustrate the situation.
5. Indicate whether the resident has been within the community for less than 24 hours, as well as confirm the use and functionality of any alarms at the time of the fall.
6. Assess the surrounding area during the fall, choosing descriptors that best represent the scene, such as cluttered, noisy, or busy.
7. Fill in the condition of the floor at the time of the incident, selecting from options like wet, dry, carpeted, or uneven.
8. Confirm whether the resident was wearing hearing aids and glasses during the fall, and answer questions about their cleanliness and condition.
9. Indicate if the resident was using any assistive device and the type, if applicable.
10. Provide details about staff assistance during resident transfers if applicable, such as how many staff members were involved.
11. At this point, address what the resident was wearing, including footwear, and note any unusual activities or behaviors that were observed within the four hours prior to the fall.
12. Document any immediate interventions implemented as a result of unusual behaviors, followed by any other relevant information that may have contributed to the fall.
13. If needed, provide a reenactment of the fall event for further information in order to conduct a root cause analysis.
14. Finally, ensure that the staff member completing the form signs it, and list the names of the Fall Huddle participants along with the date and time.
15. In the 'Root Cause of Fall' section, the licensed nurse should identify contributing factors by selecting all that apply from the checklist provided.

Complete the Fall Investigation Worksheet online to enhance safety and care plans.