The purpose of the study was to develop a preliminary Fall Risk Screening tool and determine the ability of the instrument to identify older adults with fall risk factors and those at-risk for future falls and fear of falling in the Emergency Department (ED) . The ED Fall Risk Screen was initially tested on 42 community-dwelling older adults in the ED who completed the screen and follow-up phases. The tool was subsequently revised by adding select physical performance tests and administered to a second cohort of 103 older adults on-site in the community. Three month follow-up was performed. Statistical analyses included logistic regression modeling for prediction of both falls and fear of falling. Fifteen of the ED patients (35.7%) had two major fall risk factors, including: previous falls, decreased leg strength, and balance and gait problems. On follow-up, three falls occurred in two people and 15.7% reported fear of falling. Of the 103 community living subjects (age: 79.3 ± 10.4 years) completing the 3-month follow-up, 76.7% had one or more major fall risk factors, 21 subjects had fallen, and 19% reported a fear of falling. Timed Up and Go Test performance slower than 12 seconds was an independent predictor of both falls and fear of falling among the community-living group (p<0.05). Select questions and objective balance and mobility tests predicted future falls by 70%, and fear of falling by 71%.