NDIS Onboarding Risk Assessment and Support/Care Plan

Participant Name*

First NameLast Name

Contact details of the Participant:

Carer/ Guardian/ Parent Name*

First NameLast Name

Mobile Number*

Area CodePhone Number

E-mail*

example@example.com

NDIS & Participant Goals

NDIS Number*

Participant Date of Birth*

How is this Plan Managed?*

Description of Support Received*

Goals & Outcomes (as per NDIS)*

Please upload a copy of the Plan or any document (if approved by client)

Emergency Contact

When the carer is unreachable

Name*

First NameLast Name

Emergency Contact Number*

Area CodePhone Number

E-mail

example@example.com

Cultural and Communication Preferenecs

Please tick the following that apply to this participant

First Nation/ Aboriginal & Torres Strait IslanderLGBTQ+CALD CommunityOther

Preferred language (if not English)

Communication Preferences

Email/ textPhoneVideo conferencesOther

Health and Medical Background

For Practictioners: Please try to fill in with as much details as possible. If unknown, please leave blank.

Allergies/ Reactions

Any other medical conditions

GP/ Practice Name

First NameLast Name

GP/ Practice Phone Number

Medication required?

YesNoUnknown

Prompt/ Assistance required?

YesNoUnknown

Please advise any other relevant details...

Schedule of Support

List Support Item (or NDIS Code)

List more than one (1) if applicable.

Select the days and times of the week where support is needed (if known)

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning (7am to 10am)
Midday (10am to 1pm)
Afternoon (1pm to 4pm)
Evening (4pm to 7pm)

Client Risks and Mitigation

Please select any known risks*

	Minor	Imminent	Severe	Critical	None identified
Personal health and hygiene
Family and community participation
Abuse and neglect (inc. domestic violence)
Freedom of choice and control
Emergency/ natural disaster (inc. flood/ bushfire, pandemic, etc)
Safety at home and easy accessibility

Please describe the risks...

Mitigation/ Monitoring Approach/ Action Plan

Key Contacts and Communiciation Plan in case of Emergency or Disaster

Please upload any files or relevant documentation associated

How did you hear about us?*

Please Specify

Is there anything else we should know about the Participant in order to best support them?

This may include: daily living needs, risks & safety concerns, behaviour support (if relevant), communication needs, etc.

I confirm that I have entered these details as per the information provided (with consent) from the Participant or their carer.*

Yes, I confirm