Emergency Readiness

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Support Coordinator
Date Emergency Plan Created

DayMonthYear
Date
Who is Completing this form?

First NameLast Name
Offline Completed Emergency Plan

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MADE TO HELP

Participant Emergency Plan

For Level 2 Support Coordination, Level 3 Specialist Support Coordination and support work

Purpose and compliance use

This plan records how Made to Help, the participant and, where consent is provided, the participant's nominee, family, carers, support network and other providers will prepare for and respond to emergencies or disasters. It must identify supports critical to the participant's health, safety and wellbeing; continuity arrangements; communication pathways; and actions required before, during and after an emergency. Prompts in this template are examples only. Workers must consider the participant's actual circumstances, risks, goals, preferences, culture, communication needs and support plan, and must escalate any unresolved or high risks under Made to Help policy.

Worker note - complex participants

If the participant is complex or high risk, mark this clearly below and complete the additional complex-client prompts. Consider review of care safety principles including dignity of risk, duty of care, supported decision making, trauma-informed practice, cultural safety, least restrictive practice, restrictive-practice/reportable-incident obligations, medication and health risks, behaviour support requirements, and whether specialist advice or additional provider coordination is required.

About Me (Participant)
Participant full name

First NameLast Name
NDIS Number
Preferred name

First NameLast Name
Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Phone Number
Completed by / role
Service Type eg. Support Coordination or Direct Supports
3 Month Review Date

DayMonthYear
Date
12 Month Review Date

DayMonthYear
Date
Version number

Review trigger	Required action / evidence
3 month review	Confirm participant details, emergency contacts, critical supports, continuity arrangements, nominee/support-network communication and worker instructions remain accurate.
12 month review	Complete full review with participant and, with consent, their support network. Reissue updated plan for review and confirmation.
Change in support needs, environment or health risk	Update plan immediately, including new risks, services, providers, communication needs, evacuation/backup arrangements and consented sharing.
Emergency/disaster warning, service disruption or worker unavailability	Activate continuity arrangements and communicate changes to participant, workers and support networks.

Preferred language/s
Interpreter / communicationsupport required
Communication format most likely to be understood
Cultural / religious considerations
Name of Nominee / authorised representative / guardian / administrator
Please include all names and roles
Consent to share emergency plan with nominee/support network
please give as much detail as you need
Complex participant / high risk?
If yes, summary of complexity / reason flagged
Client instruction:

The participant should send a copy of this emergency plan to their nominee/s, authorised representative/s and agreed emergency support people. Made to Help will also email the completed plan to the participant for review and, where appropriate and with consent, to the support network for confirmation of content.

Person / Organisation (requires an answer in every row)

Rows	Role	Phone	Email	Has copy of plan?	Consent confirmed?
First emergency contact
Family / guardian / nominee
Carer / informal support
Doctor / GP
Pharmacy / chemist
NDIS planner / LAC
NDIS support provider
Neighbour / community contact

Consider reasonably foreseeable emergencies that may affect the participant, their supports, workers or the community. Prompts are examples only and must be adapted to the participant and locality.

Emergency / disaster scenario

Rows	Participant-specific risks	Preparation actions	Response actions	Recovery / follow-up actions
Bushfire / smoke / extreme heat
Flood / storm / power outage
Pandemic / infectious disease outbreak
Medical emergency / deterioration
Behavioural crisis / violence / immediate safety threat
Housing, transport or community access disruption
Provider/worker absence or service interruption

Identify the degree to which the participant relies on each support and what would happen if that support was disrupted. Supports that are critical to daily living, health, safety, communication, medication, behaviour support or personal care require clear backup arrangements.

Support / activity

Rows	Provider / person responsible	Frequency	Criticality if disrupted	Backup / alternative arrangement	Participant agreement recorded?
Support coordination
Specialist support coordination
Personal care
Medication support / health care
Meals / nutrition / hydration
Transport / community access
Communication support / assistive technology
Behaviour support / restrictive practice safeguards
Domestic assistance / support work
Informal support / family or carer role

Required standard

Alternative arrangements for continuity of supports, where changes or interruptions are unavoidable, must be explained and agreed with the participant and delivered in a way that is appropriate to their needs, preferences and goals. Changes must be communicated to workers, the participant and, with consent, their support network.

Potential interruption / change

Rows	Risk to participant if support changes	Continuity or alternative arrangement	Who approves / coordinates?	How participant and network are told	Worker instruction
Worker unavailable
Support coordinator unavailable
Provider unable to deliver service
Participant cannot be contacted
Participant needs urgent escalation
Emergency services / evacuation required
Technology or communication failure
Transport unavailable

Client Instruction: The participant should send a copy of this emergency plan to their nominee/authorized representative/s and agreed emergency support people. Made to Help will also email the completed plan to the participant for review and, where appropriate and with consent, to the support network for confirmation of content.

Rows	Yes/No	Evidence
Has the correct information been relayed to the plan nominee regarding the emergency plan and continuity of supports?
Have changes to supports been explained to the participant in their preferred communication style?
Has the participant agreed to the proposed alternative arrangements, where possible?
Are arrangements appropriate to the participant's needs, preferences and goals?
Have relevant workers received the current plan and instructions?
Have relevant providers/support networks been informed with participant consent?

Leaving in an Emergency

Rows	Answer
When I will leave / evacuate
Where I will go / evacuation point
How I will get there
Person driving / assisting transport
Backup plan if transport/support person unavailable
Shelter-in-place location / strategy
Mobility or access needs during evacuation
Pets / assistance animals plan

Exit/ Access Consideration

Rows	Response	Action
Two safe exit points from building/property identified
Keys, codes, gates and building access instructions available
Emergency backpack location known
Assistive technology, chargers and backup power considered
Medication and medical supplies available for at least 3 days where appropriate
Evacuation plan suitable for participant mobility, cognition and communication needs

Area

Rows	Details	Emergency action / worker instruction
Medical conditions / chronic health risks
Medication and dosage requirements
Allergies / anaphylaxis / EpiPen
Dietary / swallowing / mealtime needs
Behaviour support needs / triggers / escalation
Mental health, distress or trauma considerations
Infectious disease / infection control needs
Equipment, aids and assistive technology

How do you communicate

Rows	Participant preference / instruction
Best way to help me understand information
How to tell me about changes to supports
How to communicate urgent risks without causing unnecessary distress
Supported decision-making preferences
Communication aids, apps, cards, visual schedules or interpreters
What helps me stay calm
What makes things worse or should be avoided

Use this checklist as a prompt. It is not exhaustive and must be tailored to the participant. Consider whether the participant, support network or worker is responsible for maintaining each item.

Item

Rows	Required?	Location / person responsible	Notes
Medication / scripts for at least 3 days where clinically appropriate
Medication list and health summary
Water and non-perishable food suitable to dietary needs
Clothing, warmth, hygiene and continence items
Mobile phone, charger, power bank
Assistive technology, spare batteries, glasses, hearing aids
Communication board/card or written cues
Important documents, ID, guardianship/nominee documents
Behaviour support plan / care plan if applicable
Personal comfort item, sensory item or calming activity
First aid kit / masks / gloves where appropriate
Pet or assistance animal supplies

Complete this section where complex/high risk is ticked

These prompts are examples only. Workers must consider whether further assessment, clinical input, behaviour support, restrictive-practice review, incident escalation, safeguarding referral, family/provider conference, or risk-register entry is required.

Complexity area Prompts

Rows	Response	Action
Health - Does the participant have chronic, unstable or high-risk health issues requiring clinical advice or urgent escalation pathways?
Medication - Are medication interruptions, storage, administration or review risks present?
Behaviour /safety - Are there behaviours of concern, violence, self-harm, coercion, abuse, neglect or exploitation risks?
Decision-making - Are nominee, guardian, consent, capacity, CTO, order or supported decision-making issues relevant?
Restrictive practices - Could emergency arrangements involve restrictive practice, environmental restraint, seclusion, chemical restraint or behaviour support requirements?
Communication - Could the participant misunderstand warnings, changes to supports or emergency instructions without tailored communication?
Provider coordination - Are multiple providers required to coordinate critical supports, and are consented information-sharing links current?
Risk register - Are any risks serious, unresolved or organisational in nature and therefore requiring transfer to Made to Help's risk register?

Risk /Issue identified - has there been any items indicated in this form, which need further action by Madetohelp. Please fill in the below.

Rows	Risk / issue identified	Treatment or action required	Responsible person	Due date	Status	Transfer to risk register?
1
2
3
4
5
6
7
8

Completion requirement

Rows	Evidenced	Details
Participant has reviewed the plan and had opportunity to request changes
Plan emailed to participant after review completion
Plan sent to support network/nominee for confirmation of content where appropriate and with consent
Participant advised to send copy to their nominee/s and agreed emergency contacts
Correct information relayed to plan nominee regarding emergency plan and continuity of supports
Current plan uploaded/stored in Made to Help record system and made available to workers who need it
Support plan updated where emergency risks, continuity arrangements or critical supports have changed
3 month review scheduled
12 month review scheduled

Document control:

This template should be reviewed against current NDIS Practice Standards, Made to Help policies, participant support plans, risk assessments, incident management requirements and local emergency information. It does not replace emergency services advice, clinical instructions, behaviour support plans, legal orders or participant-specific professional advice.
Communication Format likely to be understood, please list;
Cultural and Religious Considerations;
Nominee/Next of kin
Consent to share Emergency Plan with plan nominee/Next of Kin
Complex/High needs participant Eg; multiple diagnosis, health related issues

Identified Supports Table;

Rows	Provider/person responsible	Frequency of supports	Critically if disrupted	Back up or alternative arrangements	Participant Agreement recorded
Transport/Community access
Communication/assistive technology
Behavior Support/Restrictive practice
Domestic Assistance/Support work
Informal support/carer role

Continuity of Supports and Changes to Supports;

Rows	Risk to participant if support changes	Continuity or alternative arrangement	Who Approves or Coordinates ?	How participant and network are told	Worker instruction
Worker unavailable
Support coordinator unavailable
Provider unable to deliver service
Participant cannot be contacted
Participant needs urgent escalation
Emergency services evacuation required.
Technology or communication failure
Transport Unavailable

When will I decide to leave or evacuate;
Where will I go evacuation point?
How will I get there?
Who will assist me with driving?
Back up person if my main driver cannot help me;
Mobility or access needed during evacuation at my home;
Do i have pets and what type of assistance do they need?
Medical Conditions (please list these)
People around me need to know that I have the following medical conditions

Health, Medication, Behavior and Well Being

Rows	Details required here;	Emergency Action and list the worker instruction here;
Medical conditions and chronic health risks
Medication and dosage requirements
Allergies, anaphylaxis and Epi pen
Dietary/ swallowing/mealtime needs
Behavior support/triggers
Mental Health/distress or trauma
Infectious Diseases/infection Control
Equipment aid, and assistive technology

The best way to help me understand information
How to tell me about changes to supports
How to communicate risk without causing significant distress
What are your communication aids, visual, apps, cards and visual representations.
What helps me stay calm?
What makes things worse or things to be avoided?
My Emergency Supports

Rows	Name	Phone	Email	Has a copy of my plan
First Contact
Family/Legal Guardian
Caregiver
Doctor
NDIS Support Provider
Chemist
Employer
Neighbour

NDIS Support Coordinator

First NameLast Name

I will leave the house when:

Rows	Comment
A family member tells me
When my carer tells me
I will leave early to be safe
When I get an alert from emergency staff
Other

Important Documents - to have ready to take with me when I leave.
Phone Number of Home Insurer
Phone Number of Car Insurer
My Health

Please list all current medications

Medications

Rows	Medication	Dosage	Time	Days/Frequency
1
2
3
4
5
6
7
8
9

Allergies

Rows	I have an allergy to	Allergy Medication	I have an EpiPen
1
2
3
4

I have the following dietary needs (eg. low sodium, lactose intolerance, gluten free)
I need the following aids to help me (eg. wheelchair, walker, continence supplies etc )
Communication
This is the best way to help me understand things:
How to Help me
My favourite thing to do is
I need these items to help me when I feel nervous or sad
How I keep calm
Other item to help keep me calm
My emergency backpack is located
Personal Care - I need help with
Other personal care help:
Emailed Copy to Participant/Next of Kin
What I will take with me "My Backpack"

When you are in a fire or emergency you need to pack a bag such as a backpack of things to get you through a few nights if you need to evacute
My Packing Checklist
Participant/ Nominee / authorised representative

First NameLast Name
Participant/ Nominee / authorised representative Signature
Participant/ Nominee / authorised representative Signature Date

DayMonthYear
Date
Support Coordinator

First NameLast Name
Support Coordinator Signature
Support Coordinator Signature Date

DayMonthYear
Date
Made to Help reviewer / manager

First NameLast Name
Made to Help reviewer / manager Signature
Made to Help reviewer / manager Signature Date

DayMonthYear
Date
Person completing this form
Date this Emergency Plan is compelted

MonthDayYear
Date

Should be Empty:

MADE TO HELP

Purpose and compliance use

Worker note - complex participants

About Me (Participant)

Client instruction:

Required standard

Complete this section where complex/high risk is ticked

Document control:

My Emergency Supports

Important Documents - to have ready to take with me when I leave.

My Health

Communication

How to Help me

What I will take with me "My Backpack"