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Customizable 'Staying Independent Checklist'

NEW  Customize this Staying Independent Checklist by adding your organization’s logo and website details or leave it as is.

Download the template

For a copy of the template without the Fall Prevention Month logo, contact Michelle Dueckman (mdueckman@parachute.ca). 

The Staying Independent Checklist is a self-screening tool for older adults to find out if they are at risk of falling. Older adults are encouraged to complete the Checklist and to follow-up with their healthcare provider as needed.