Manual Index Executive Summary Table of Contents Chapter 1. Overview of SAFE Appendix 1 Description of Kaiser Permanente and the Center for Health Research Chapter 2. Sampling Procedures Chapter 3. Participant Recruitment Procedures Appendix 3A Initial SAFE Solicitation Letter Appendix 3B Solicitation of Fact Sheet Appendix 3C Solicitation Remail Appendix 3D Incoming Phone log Appendix 3E Falls Fact Sheet – Telephone Recruitment Appendix 3F SAFE Home Visit Appointment Reminder Form Appendix 3G Welcome Letter Chapter 4. Home and Physical Assessments Appendix 4A Falls History Questionnaire Appendix 4B Fall Report Postcard Appendix 4C Home Profile Appendix 4D Physical Assessment Appendix 4E Brief Physical Assessment Appendix 4F Home Visit Problem Report Appendix 4G Member Satisfaction Procedure Brochure Appendix 4H Request for Action Appendix 4I Assessment Packet Procedures Appendix 4J Appointment Reminder Guide Appendix 4K Consent Form Appendix 4L Consumer Products Safety Commission Home Safety Booklet Appendix 4M Falls Prevention Program Reminder Form (Blue) Appendix 4N Falls Prevention Program Reminder Form (White) Appendix 4O Assessor Procedure Checklist Appendix 4P Experimental Group Assignment Form Appendix 4Q Health Behavior Card Appendix 4R Transportation Card Appendix 4S Unscheduled Home Visit Letter #1 Appendix 4T Unscheduled Home Visit Letter #2 Appendix 4U Unscheduled Home Visit Mail-in Form Chapter 5. Health Behavior Intervention Appendix 5A Health Behavior Program Outline Appendix 5B Syllabus for Health Behavior Sessions Appendix 5C Falls Fact Sheet Appendix 5D Falls Prevention Program Questionnaire Appendix 5E Behavior Risk Action Plan Appendix 5F Walking Guide Appendix 5G Falls Prevention Exercises Appendix 5H Safety Action Plan Appendix 5I Senior Job Center Handout Appendix 5J Willamette Valley Healthcare Handout Appendix 5K Care Medical Fact Sheet Appendix 5L Portland Development Commission Handout Appendix 5M Property Tax Deferral Fact Sheet Appendix 5N Calcium Intake Handout Appendix 5O Calcium Supplement Handout Appendix 5P Medicine Safety Handout Appendix 5Q Emergency Medical Alarm System Handout Appendix 5R Falls Prevention Program Evaluation Appendix 5S Health Behavior Card Appendix 5T Health Behavior “Make-up” Letter #1 Appendix 5U Health Behavior “Make-up” Letter #2 Appendix 5V Health Behavior Reunion Meeting Letter Appendix 5W Health Behavior Reunion Meeting Flyers Appendix 5X Health Behavior Reunion Meeting Postcard Appendix 5Y Health Behavior Reunion Telephone Script Appendix 5Z Reunion Meeting Attendance Card Appendix 5AA Reunion Meeting Syllabus – Series #1 Calcium and Blood Pressure Appendix 5BB The SAFE Calendar Appendix 5CC Reunion Meeting Syllabus – Series #2 Crime Prevention Crime Prevention Resources Crime Prevention Checklist Advanced Exercises Appendix 5DD Reunion Meeting Syllabus – Series #3 Nutrition Nutrition Bingo Safety Improvement Goals Appendix 5EE Reunion Meeting Syllabus – Series #4 Foot Care Kaiser Permanente Foot Care Resources Foot Care Information Appendix FF Reunion Meeting Syllabus – Series #5 Exercise for Lifetime Falls Prevention Review Exercise Directory Chapter 6. Home Safety Improvement Intervention Appendix 6A Safety Equipment Telephone Survey Appendix 6B Home Repair Authorization Form Appendix 6C Senior Job Center Fact Sheet Appendix 6D Supplemental Form to Notify Senior Job Center Workers of Outstanding Safety Awards Appendix 6E Portland Development Commission Fact Sheet Appendix 6F Property Tax Deferral Fact Sheet Appendix 6G Willamette Valley Fact Sheet Appendix 6H Care Medical Fact Sheet Appendix 6I Bathroom Fact Sheet Chapter 7. Participant Tracking Procedures Appendix 7A Request for Action Form Chapter 8. Home Safety Reassessments Appendix 8A Second Brief Physical Assessment Appendix 8B Reassessment Packet Procedures Appendix 8C Reassessment Home Profile Appendix 8D Assessor Procedure Checklist for Reassessments Chapter 9. Data Collection Procedures Appendix 9A Medical Record Protocol Appendix 9B Falls History Questionnaire (FHQ) Appendix 9C First Annual Survey (FAS) Appendix 9D Second Annual Survey (SAS) Appendix 9E Postcard Fall Report (PFR) Appendix 9F Fall Contact Record Appendix 9G Quarterly Fall Verification (QFV) Appendix 9H Quarterly Falls Telephone Survey (QFTS) Appendix 9I Telephone Fall Report (TFR) Appendix 9J Fall Incident Report (FIR) Appendix 9K Fall Report Acknowledgement Letter Appendix 9L Center for Health Research Confidentiality Pledge Appendix 9M Kaiser Permanente Confidentiality Pledge for Students Appendix 9N Falls History Questionnaire (FHQ) Coding Instructions Appendix 9O First Annual Survey (FAS) Coding Instructions Appendix 9P Second Annual Survey (SAS) Coding Instructions Appendix 9Q Physical Assessment (PA) Coding Instructions Appendix 9R Brief Physical Assessment (BPA) Coding Instructions Appendix 9S Brief Physical Assessment, Version 2, (BPA-2) Coding Instructions Appendix 9T Home Profile (HP) Coding Instructions Fall Report Coding Instructions Appendix 9V Health Behavior (HB) Pre-/Post- Survey Coding Instructions Appendix 9W Safety Equipment Telephone Survey (SETS) Coding Instructions Appendix 9X Home Repair Authorization (HR) Coding Instructions Appendix 9Y Quarterly Fall Telephone and Verification Survey (QFTS/QFV) Coding Instructions Chapter 10. Close-Out Procedures Appendix 10A Closeout Letter to SAFE Participants Appendix 10B Closeout Letter to Lost To Follow-up Participants Appendix 10C Follow-up Letter for Second Annual Survey