* 1. Have you fallen within the past 6 months?

* 2. Have you fallen within the past year?

* 3. Are you afraid of falling?

* 4. What are some precautionary steps that you take to prevent falling?

* 5. What, as a DEPARTMENT, could we do to ensure safety from falling for our elders?

* 6. What do you think causes the most falls among elders?

* 7. If you answered other- what other reasons do you feel cause the most falls among elders?

* 8. Name & Size of YakTrax (For YakTrax Tracking purposes ONLY)

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