Survey Text

2017 2012 2007 2002
2016 2011 2006 2001
2015 2010 2005 2000
2014 2009 2004 1999
2013 2008 2003 1998
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2017
Survey form view entire document:  text  image
Question ID:FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text:

(book) F7 * Enter up to 2 responses, separate with a comma.
* Ask or verify. How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:

go to IFALLWHY

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2016
Survey form view entire document:  text  image
Question ID:FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text:

(book) F7 * Enter up to 2 responses, separate with a comma.
* Ask or verify. How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:

go to IFALLWHY

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2015
Survey form view entire document:  text  image
Question ID:FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text:

(book) F7 * Enter up to 2 responses, separate with a comma.
* Ask or verify. How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:

go to IFALLWHY

top
2014
Survey form view entire document:  text  image
Question ID:FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text:

(book) F7 * Enter up to 2 responses, separate with a comma.
* Ask or verify. How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:

go to IFALLWHY

top
2013
Survey form view entire document:  text  image
Question ID:FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text:

(book) F7 * Enter up to 2 responses, separate with a comma.
* Ask or verify. How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:

go to IFALLWHY

top
2012
Survey form view entire document:  text  image
Question ID:FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text:

(book) F7 * Enter up to 2 responses, separate with a comma.
* Ask or verify. How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:

go to IFALLWHY

top
2011
Survey form view entire document:  text  image
Question ID:FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text:

(book) F7 * Enter up to 2 responses, separate with a comma.
* Ask or verify. How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:

go to IFALLWHY

top
2010
Survey form view entire document:  text  image
Question ID:FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text:

(book) F7 * Enter up to 2 responses, separate with a comma.
* Ask or verify. How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:

go to IFALLWHY

top
2009
Survey form view entire document:  text  image
Question ID: FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text: (book) F7
* Enter up to 2 responses, separate with a comma.
* Ask or verify.
How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text: All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:
goto IFALLWHY

top
2008
Survey form view entire document:  text  image
Question ID: FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text: (book) F7
* Enter up to 2 responses, separate with a comma.
* Ask or verify.
How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text: All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:
goto IFALLWHY

top
2007
Survey form view entire document:  text  image
Question ID: FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text: (book) F7
* Enter up to 2 responses, separate with a comma.
* Ask or verify.
How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text: All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:
goto IFALLWHY

top
2006
Survey form view entire document:  text  image
Question ID: FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text: (book) F7
* Enter up to 2 responses, separate with a comma.
* Ask or verify.
How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text: All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:
goto IFALLWHY

top
2005
Survey form view entire document:  text  image
Question ID: FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text: (book) F7
* Enter up to 2 responses, separate with a comma.
* Ask or verify.
How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text: All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:
goto IFALLWHY

top
2004
Survey form view entire document:  text  image
Question ID: FIJ.130_00.000

Instrument Variable Name: IFALL
Question Text: (book) F7
* Enter up to 2 responses, separate with a comma.
* Ask or verify.
How did [fill: you/ALIAS] fall? Anything else?
01 Stairs, steps, or escalator
02 Floor or level ground
03 Curb (including sidewalk)
04 Ladder or scaffolding
05 Playground equipment
06 Sports field, court, or rink
07 Building or other structure
08 Chair, bed, sofa, or other furniture
09 Bathtub, shower, toilet, or commode
10 Hole or other opening
11 Other
97 Refused
99 Don't know
Universe Text: All medically-consulted injury episodes that occurred due to a fall
Skip Instructions:
goto IFALLWHY

top
2003
Survey form view entire document:  text  image
FIJ.171

FR: VERIFY OR ASK. SHOW FLASHCARD F4. RECORD UP TO 2 RESPONSES: ENTER (N) FOR NO MORE.

How did {you/subject name} fall? Anything else?

On or down, from or into:
Card F4
On or down from or into:

1. Stairs, steps or Escalator
2. Floor/Level ground
3. Curb, including sidewalk
4. Ladder or scaffolding
5. Playground equipment
6. Building or other structure
7. Chair, bed, sofa, or other furniture
8. Bathtub, shower, toilet or commode
9. Hole or other opening
10. Other
FALLNEW1
FALLNEW2
(01) Stairs, steps, or escalator
(02) Floor/level ground
(03) Curb, including sidewalk
(04) Ladder or scaffolding
(05) Playground equipment
(06) Building or other structure
(07) Chair, bed, sofa or other furniture
(08) Bathtub, shower, toilet, or commode
(09) Hole or other opening
(10) Other
(97) Refused
(99) Don't know
[ ]
[ ]

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2002
Survey form view entire document:  text  image
FIJ.171

FR: VERIFY OR ASK. SHOW FLASHCARD F4. RECORD UP TO 2 RESPONSES: ENTER (N) FOR NO MORE.

How did {you/subject name} fall? Anything else?

On or down, from or into:
Card F4
On or down from or into:

1. Stairs, steps or Escalator
2. Floor/Level ground
3. Curb, including sidewalk
4. Ladder or scaffolding
5. Playground equipment
6. Building or other structure
7. Chair, bed, sofa, or other furniture
8. Bathtub, shower, toilet or commode
9. Hole or other opening
10. Other
FALLNEW1
FALLNEW2
(01) Stairs, steps, or escalator
(02) Floor/level ground
(03) Curb, including sidewalk
(04) Ladder or scaffolding
(05) Playground equipment
(06) Building or other structure
(07) Chair, bed, sofa or other furniture
(08) Bathtub, shower, toilet, or commode
(09) Hole or other opening
(10) Other
(97) Refused
(99) Don't know
[ ]
[ ]

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2001
Survey form view entire document:  text  image
FIJ.171

FR: VERIFY OR ASK. SHOW CARD F3. RECORD UP TO 2 RESPONSES:
ENTER (N) FOR NO MORE.

How did (you/subject name) fall? Anything else?

On, down, from, or into:
CARD F3
You may choose more than one.

On or down from or into:
1. Stairs, steps or escalator
2. Floor/Level ground
3. Curb, including sidewalk
4. Ladder or scaffolding
5. Playground equipment
6. Building or other structure
7. Chair, bed, sofa or other furniture
8. Bathtub, shower, toilet or commode
9. Hole or other opening
10. Other

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2000
Survey form view entire document:  text  image
FALLNEW
(01) Stairs, steps, or escalator
(02) Floor/level ground
(03) Curb, including sidewalk
(04) Ladder or scaffolding
(05) Playground equipment
(06) Building or other structure
(07) Chair, bed, sofa or other furniture
(08) Bathtub, shower, toilet, or commode
(09) Hole or other opening
(10) Other
(97) Refused
(99) Don't know
[ ]
[ ]

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1999

No questionnaire text is available for this sample.


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1998

No questionnaire text is available for this sample.