The objectives of this study were to develop the Self-Awareness of Falls in Elderly (SAFE) scale and test its reliability and validity among elderly inpatients. A cross-sectional study design and convenience sampling were used to test the validity and reliability of the SAFE scale. Explanatory factor analysis and confirmatory factor analysis yielded an acceptable goodness of model fit, confirming the 21 items in the SAFE scale that were distributed among four factors: awareness of activity safety and environment, awareness of physical functions, awareness of medication, and awareness of cognitive behavior. The values of interrater reliability and Cronbach’s alpha were at least .70, indicating that reliability of the SAFE scale was acceptable. The SAFE scale is the first instrument to measure self-awareness of fall risk among high-risk groups. Further management and fall prevention can then be designed to reduce the incidence of falls among elderly people in clinical care.