My Living Alone Risk Plan

My Living Alone Risk Plan
Participants Details
Given name/s:
Preffered name:
Family name:
Date of birth:

MonthDayYear
Date
NDIS Number:
PARTICIPANTS LIVING ALONE - SOLE SUPPORT WORKER
(Daily personal activities support)
Select all applicable risks for given risk categories.
Personal contact

No regular face-to-face contact with other NDIS providersLimited or irregular face-to-face contact with relatives, friends or other people
Physical Mobility

Relies on other people to be physically mobile or to facilitate their physical mobilityUses equipment to enable them to be physically mobile or to facilitate their physical mobility.
Communication

Without the assistance of another person the participant has limited or no ability to communicate.The participant uses equipment to enable or facilitate communication with others, including to enable or facilitate the use of a phone or other device.
Daily Personal Activities-Sole support worker(for participants living alone)
Sole support worker?
Reason:
NOTE: IF SUPPORTERS ARE DILIVERED BYA SOLE SUPPORTWORKER AND ANY OF THE ABOVE RISKS APPLY:

Treat clint riskson the MANAGEMENT page and creat a MONITORING and Supervision Plan below.

RISK TREAMENT - PARTICIPENT LIVING ALONE (SOLE SUPPORT WORKER)

SUPPORT WORKERS DETAILS:
Family name:
Mobile phone:
Please enter a valid phone number.
Given names:
Email Adress:
example@example.com
SECTION CRITERIA
Worker suitability

Mandatory NDIS Worker Orientation ModuleNDIS worker Screening check/National Police Check100 ptsI.D. on fileOther (Comments)
Participant Requirements / Prefences
Worker Competencies
Please select

Relevant qualifications (not applicable)Relevant experienceFeedback processReporting processIncident reporting processCan identify and respond to all risks identified aboveOther factors:Other / Comments
Specify relevant qualifications
Specify relevant experience
Specify Other factors:
WORKER REPORTS SUBMITTED TO
Name
Position / Role
Email address
example@example.com
Phone
Please enter a valid phone number.
RISK MONITORING AND SUPERVISION PLAN

Participants Living Alone – Sole Support Worker
Participant Risk
Identified Risk
Comment
Risk Level
Monitoring Types and Frequencies

Communication with participant
Feedback
In-person
Other Specify
Worker Reports
On-site Monitoring
On-site Supervision
Other Supervision
Do you want to add more?

YesNo
Participant Risk
Identified Risk
Comment
Risk Level
Monitoring Types and Frequencies

Communication with participant
Feedback
In-person
Other Specify
Worker Reports
On-site Monitoring
On-site Supervision
Other Supervision
Do you want to add more?

YesNo
Participant Risk
Identified Risk
Comment
Risk Level
Monitoring Types and Frequencies

Communication with participant
Feedback
In-person
Other Specify
Worker Reports
On-site Monitoring
On-site Supervision
Other Supervision
Do you want to add more?

YesNo
Participant Risk
Identified Risk
Comment
Risk Level
Monitoring Types and Frequencies

Communication with participant
Feedback
In-person
Other Specify
Worker Reports
On-site Monitoring
On-site Supervision
Other Supervision
Do you want to add more?

YesNo
Participant Risk
Identified Risk
Comment
Risk Level
Monitoring Types and Frequencies

Communication with participant
Feedback
In-person
Other Specify
Worker Reports
On-site Monitoring
On-site Supervision
Other Supervision
Should be Empty: