More than 1 in 4 older adults fall each year. Less than half tell their doctor.
Falling once doubles the chance of falling again. Falls can be prevented.
The CDC’s advice comes down to four things: speak up about falls, keep moving, have your eyes checked every year, and make your home safer.
This planner turns those four steps into pages you can fill in, and a record you can bring to every appointment.
Eight weeks, step by step
Take the 12-question checklist. Fill in your care team, medicines and fall plan. Walk through the home check, room by room.
Log every fall, near miss and dizzy spell. Do the CDC chair-rise exercise on the days your doctor suggests, and tick off home fixes.
Take the checklist again, fill in your review, and bring the planner to the doctor.
For the person at risk, and the family who helps.
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1Fall & near-miss logWhere, when, what happened, any injury, how you got up, and what you changed after.
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2Dizziness log + getting up slowlyThe CDC’s steps for dizziness on standing, and a log to show the doctor when it happens.
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3Home check + fix planThe CDC home safety checklist, room by room, with a fix plan to tick off.
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4For family caregiversSigns worth noticing, ways to help, and what to do after a hospital stay.
41 pages to record, check and strengthen
Pages shown with example entries.
What this planner is, and isn't
It is
- A clear record of falls, near misses and dizzy spells
- The CDC’s own checklists and exercise, in one place
- Something to bring to every appointment
- Yours to keep: no app, no subscription, no login
It isn't
- Medical advice, or a diagnosis
- A replacement for your doctor or physical therapist
- A reason to change a medicine on your own
- A paper book (it’s a PDF you print or fill in)
- CDC Stay Independent fall risk checklist
- Fall & near-miss log, dizziness log
- If you fall: what to do, and My Fall Plan
- Room-by-room home check and fix plan
- Medicine review, eyes, feet and shoes
- CDC chair-rise exercise, 8-week activity tracker
- Caregiver and after-hospital pages, 3 doctor-visit pages
- Large print, fillable, US Letter + A4
Good to know
Where does the content come from?
From the CDC’s STEADI materials for older adults and families: the Stay Independent checklist, the Check for Safety home checklist, What You Can Do to Prevent Falls, the postural hypotension leaflet and the Chair Rise Exercise. The after-a-fall steps follow the NHS, adapted for U.S. emergency numbers.
I'm filling it in for my mother or father. Does that work?
Yes. Every page works for a family caregiver, and there are pages just for you: signs worth noticing, ways to help, and what to do after a hospital stay.
Is the exercise safe for me?
Ask your doctor which exercise program is right for you before you start, especially if you have fallen or feel unsteady. The planner includes the CDC’s chair-rise exercise and space for your own plan from a doctor or physical therapist.
Can I fill it in on my phone?
Yes, with the free Adobe Acrobat Reader app. On a computer, open it in Chrome, Edge or Adobe Acrobat Reader and save after each entry. Or print it and write by hand.
Is it dated?
No. Write your own dates, and start any time.
Chair Exercise Bundle for Seniors
Chair Yoga, Chair Tai Chi and Tai Chi Walking, together: gentle routines for strength and balance.
One checklist. One walk through the home. A safer month.
Take the 12-question check today, and bring the planner to the next appointment.
Get the planner · $12