Falls Prevention Partnership Survey

We Need Your Input!

The purpose of this survey is to get member feedback to help us plan the future direction of the Falls Prevention Partnership. The questionnaire allows you to provide information about your experiences anonymously.

This survey should take about 10 minutes to complete.

Question Title

* 1. Which of the following falls prevention activities have you participated in over the past 3 years? (Select all that apply)

Hosted a Falls Prevention Partnership meeting

Attended a Falls Prevention Partnership meeting

Presented at a Falls Prevention Partnership meeting

Became a certified Matter of Balance Master Trainer

Became a certified Matter of Balance Coach

Co-facilitated a Matter of Balance workshop

Hosted a Matter of Balance workshop at your facility

Participated in a Falls Prevention Awareness Day event

Helped organize or presented at the August 2014 Falls Prevention Summit

Attended the August 2014 Falls Prevention Summit at UTC

Attended the February 2014 Falls Prevention Forum at the Health Department

None of these

Other (please specify)

Question Title

* 2. We are interested in how the Falls Prevention Partnership may have inspired or influenced falls prevention activities among its member organizations. Please describe any falls prevention activities that you have provided to each of the following groups.

Staff

Members/clients

Residents

Residents' families

Community groups

Community-at-large

Other

Question Title

* 3. What else could be done in Hamilton County to help reduce falls among older adults? This is an opportunity to think outside the box. New and innovative ideas are welcome!

Question Title

* 4. What type of organization do you represent?

Independent living facility

Assisted living facility

Nursing home facility

Educational institution

Government agency

Nonprofit/community-based organization

For profit organization

Faith based organization

Professional or industry organization

Public/private partnership

Hospital or health center

Private citizen or volunteer

Other (please specify)

Falls Prevention Partnership Survey

We Need Your Input!

Question Title

* 1. Which of the following falls prevention activities have you participated in over the past 3 years? (Select all that apply)

Question Title

* 2. We are interested in how the Falls Prevention Partnership may have inspired or influenced falls prevention activities among its member organizations. Please describe any falls prevention activities that you have provided to each of the following groups.

Question Title

* 3. What else could be done in Hamilton County to help reduce falls among older adults? This is an opportunity to think outside the box. New and innovative ideas are welcome!

Question Title

* 4. What type of organization do you represent?

Question Title

* 5. What is your role in your organization?

Question Title

* 6. Please share any additional information or comments.