Step Ahead E-Learning Module Registration Form

Thank you for registering for the Step Ahead to Fall Prevention Online E-learning Module, developed in partnership between Toronto Public Health and York Region Public Health. 

This E-module is offered to agencies and individuals providing care to older adults living independently in their own homes. The goal is to empower caregivers to incorporate falls prevention knowledge and skills into their daily work with older adults. Please complete the following questions to sign up. 
 
Notice of Collection: The information on this form is collected under the authority of the Health Protection and Promotion Act, s. 9.  It will only be used for the purpose of providing instructions to participants on how to access the E-learning Module, to send a follow up survey to participants after 3-month and for aggregate statistical reporting.  The information collected in the 3 month follow-up survey will be used to help to inform our programming and support learning needs related to falls prevention.  If you have any questions about this collection, please contact the Toronto Public Health, Health Promotion Specialist for Injury Prevention, 399 The West Mall, M9C 2Y2, or by telephone at 416-338-7600.
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2. Which of the following best describes your current profession?

3. What are the first three characters of the postal code where you work or live? (Fill one field only)

4. Why did you want to complete this e-Module? (Please check all that apply)