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Item

Was there a history of falling? (immediate or within 3 months)

Was there a secondary diagnosis?

What ambulatory aid used?

Was there an intravenous apparatus or a heparin lock inserted?

How was the patient's gait or transferring mode?

What is the mental status of the patient?

Completion

Risk Rating Reference:
• Look at the total score above and select the relevant risk level.

risk level.PNG

Overall Risk Rating

Attending Nurse's Full Name and Signature

Morse Fall Risk Assessment Checklist

Created by: SafetyCulture Staff | Industry: General | Downloads: 60

This Morse Fall Risk Assessment Tool derived from the Morse Fall Scale (MFS) was converted using iAuditor and is used to help assess a patient’s likelihood of falling. Perform this Morse Fall Risk Assessment by answering 6 essential questions. This template includes a risk rating table which will help you assign a fall risk rating (High, Medium, Low) based on the responses to the 6 essential questions.

Signup for a free iAuditor account to download and edit this checklist. It will be added to your free account and you will be able to conduct inspections from your mobile device.

Download and edit this free checklist

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Audit

Item

Was there a history of falling? (immediate or within 3 months)

Was there a secondary diagnosis?

What ambulatory aid used?

Was there an intravenous apparatus or a heparin lock inserted?

How was the patient's gait or transferring mode?

What is the mental status of the patient?

Completion

Risk Rating Reference:
• Look at the total score above and select the relevant risk level.

risk level.PNG

Overall Risk Rating

Attending Nurse's Full Name and Signature