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Tools for Living Well Toolkit - Canadian Association of Occupational ...

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82<br />

Evaluation <strong>Tools</strong><br />

6. Do you think that your knowledge about the following has changed?<br />

Assistive Device Yes No Comments<br />

Grab bar<br />

Bath bench or seat<br />

Non-slip bath mat <strong>for</strong><br />

outside the tub /shower<br />

Non-slip bath mat <strong>for</strong><br />

inside the tub / shower<br />

7. In the past 6 months, have you received requests <strong>for</strong> rooms equipped with the following bath safety<br />

devices?<br />

a) Bath grab bars: ___Yes ___No ___Don’t know<br />

b) Bath benches or seats: ___Yes ___No ___Don’t know<br />

c) Non-slip mats <strong>for</strong> inside the bathtub: ___Yes ___No ___Don’t know<br />

d) Non-slip mats <strong>for</strong> outside the bathtub: ___Yes ___No ___Don’t know<br />

8. Have you had any reported falls on your premises in the past year?<br />

___No<br />

___Yes…if yes, did any <strong>of</strong> these take place while your client was taking a bath or<br />

shower (e.g. getting in or out <strong>of</strong> the bathtub, during a shower or bath)<br />

___No ___Yes ___Don’t know<br />

9. Do you have any other comments about the <strong>Tools</strong> <strong>for</strong> <strong>Living</strong> <strong>Well</strong> program?<br />

<strong>Tools</strong> <strong>for</strong> <strong>Living</strong> <strong>Well</strong><br />

Evaluation Tool 6

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