Data Collection Process for Wisconsin Stepping On Leaders


We will send (12) copies of everything you need to do this Data Collection and surveys. This will include instructions, informational sheets, a script, copies of the Baseline Questionnaire and separate Questionnaires to administer at the 7th session, the Attendance Log, and a pre-labeled return envelope. The instructions we send you explain everything and all of the materials are color-coded.   We will send this packet to the individual you list on the Workshop Notification Form for your Stepping On workshop.



In the meantime, here’s a short summary:

  1. At the first session, you will distribute the Baseline Questionnaires, and read the script with information about the study. 
  2. At the end of the last (7th) session, you will ask participants to complete the “Post Program Survey” which includes the “Falls Behavioral Scale”.
  3. You will make copies of the first four pages of each questionnaire and Attendance Log and give to your county aging unit/ADRC to enter into the “SAMS” system.
  4. You will send all of the original completed questionnaires (Baseline and “Post Program Survey”) and the Attendance Log to WIHA in the envelope provided.
  5. You’ll make copies of the Booster Session surveys and distribute to participants at the Booster Session and then return them in the second envelope provided. 


We, will keep participants’ names and contact information confidential.  As always, filling out the questionnaires is completely voluntary and participants are not required to do so to participate in the program.  


We will send the the person designated on your Workshop Notification Form the data collection packet about a week before the start of your workshop with additional information.  For leaders who get their Workshop Notification Form in more than 3 weeks prior to their workshop start date we are also including two $5 gift cards as a small “thank you” for administering the pre- and post-surveys. 

Please let us know if you have any questions after reading through the materials. Thanks for all you do help prevent falls among older adults in Wisconsin!


Morgan Walsh, Adminstrative Assistant, 608-243-5692


Forms and Instructions to print if you are short on time or need more than 12 sets:

Letter to Stepping On Workshop Leaders with Script

Step by Step Instructions

General Attendance Log

Stepping On Baseline Questionnaire for Session 1   (PDF) 10.4.16

Post Program Survey 

Booster Session Packet





Fidelity Coaches will use this Fidelity Monitoring Tool for your fidelity coaching session at Session 3, 4, 5, or 6, as appropriatey scheduled.



Workshop Evaluation - ALL WISCONSIN COUNTIES:

Make a copy for each participant and distribute at Session 7. Invite participants to complete and then collect and review for your own purposes. You do not need to send them to WIHA.

Workshop Participant Evaluation