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Interpreter required Identifies as Aboriginal and/or Torres Strait Islander

Guardianship and/or Administration order in place Behaviour Management Plan in place Someone has authority to act for the participant NDIS plan available

Primary carer Lives with participant Emergency contact

Primary carer Lives with participant Emergency contact

Medication Plan and Consent Form completed Self-Medication Assessment completed Medication Risk Indemnity Form completed

Medication Plan and Consent Form — Medication Assessment Tool

YesNo

Medication Plan and Consent Form — Strategies Developed

YesNo

Medication Plan and Consent Form — Identified in Support Plan

YesNo

Medication – Self Medication Assessment — Medication Assessment Tool

YesNo

Medication – Self Medication Assessment — Strategies Developed

YesNo

Medication – Self Medication Assessment — Identified in Support Plan

YesNo

Medication Risk Indemnity Form — Medication Assessment Tool

YesNo

Medication Risk Indemnity Form — Strategies Developed

YesNo

Medication Risk Indemnity Form — Identified in Support Plan

YesNo

Behaviour Support Plan documents collected for authorisation Behaviour Support Plan available on NDIS portal

Individual Risk Assessment Profile completed Safety Environment Checklist — Home completed Participant Safe Environment Risk Assessment completed Nutrition and Swallowing Risk Checklist completed

Individual Risk Assessment Profile — Risk Assessment Tool

YesNo

Individual Risk Assessment Profile — Strategies Developed

YesNo

Individual Risk Assessment Profile — Identified in Support Plan

YesNo

Safety Environment Checklist — Home — Risk Assessment Tool

YesNo

Safety Environment Checklist — Home — Strategies Developed

YesNo

Safety Environment Checklist — Home — Identified in Support Plan

YesNo

Participant Safe Environment Risk Assessment — Risk Assessment Tool

YesNo

Participant Safe Environment Risk Assessment — Strategies Developed

YesNo

Participant Safe Environment Risk Assessment — Identified in Support Plan

YesNo

Nutrition and Swallowing Risk Checklist — Risk Assessment Tool

YesNo

Nutrition and Swallowing Risk Checklist — Strategies Developed

YesNo

Nutrition and Swallowing Risk Checklist — Identified in Support Plan

YesNo

I confirm the information provided is true and correct *