| No risk | Low risk | Moderate risk | High risk | |
| Medical factors (e.g., healthcondition, disability, impact of medication) | ◻ | ◻ | ◻ | ◻ |
| Balance and mobility problems | ◻ | ◻ | ◻ | ◻ |
| Visual or sensory problems | ◻ | ◻ | ◻ | ◻ |
| Level of fitness/inactivity | ◻ | ◻ | ◻ | ◻ |
| Psychological factors (e.g., anxiety, fear of falling) | ◻ | ◻ | ◻ | ◻ |
| Environmental factors (e.g., stair design, stair covering, presence of handrail, lighting, obstacles) | ◻ | ◻ | ◻ | ◻ |
| Personal behaviour (e.g., rushed movement, distracted attention, carrying items, alcohol consumption) | ◻ | ◻ | ◻ | ◻ |
| Demographic factors (e.g., living alone) | ◻ | ◻ | ◻ | ◻ |