American Fork Fire Department Falls Prevention

Welcome to our Home Safety Survey and thank you for your participation! It will take just a few minutes to finish. Fill in your information below to get started.

You

Are you concerned about falling?

Assistive Devices

Do you use an assistive device, such as walking sticks, a cane or a walker?

Extension Cords

Do you have extension cords across normal walkways in your home?

Stair Rails

Do you have stair rails both inside and outside your home? Do you use them?

Safety Rails

Do you have safety rails in your shower/bathtub?

Throw Rugs

Do you have area or throw rugs?

Getting Help

If you fell, do you have a way to contact help on your person at all times?

First Responder Access

Do you have a way for first responders to get into your locked home if you had a fall? (ie. Lockbox, garage code)

Vision

Have you had your vision checked in the last 12 months?

Fall History

Have you had a fall in the last 12 months?