Open Care Connect — Participant Intake

Step 2 — Support Matching Assessment

PP-MAT-001 | V1.1 | Custodian: Service Manager

Complete this assessment to identify the right support worker(s) for this participant. Document specific requirements — language, experience, skills — so rostering decisions are informed and consistent.

Participant Requirements

Support needs summary

Communication style and preferences

Cultural / linguistic background considerations

Support Worker Requirements

Skills required

Experience required

Language required

Gender preference (participant's preference)

No preference Male preferred Female preferred

Interests / hobbies (to assist with matching and rapport)

Specific requirements — pets, allergies, mobility at home, etc.

Worker Matching — Recommended Workers

Worker Name / ID	Skills Match	Availability Match	Preference Match	Recommended?
				Y N

Step 2 of 6

Step 3 — Participant Orientation Checklist

PT-ORC-001 | V1.1 | NDIS Practice Standards 1.3, 1.5, 2.3

Complete this checklist with the participant and/or their representative at commencement of services. All items marked complete were genuinely covered. A signed copy is filed in Section 01 (Intake & Consent) of the participant's file.

Service Commencement Date

Orientation Completed By (OCC Staff)

Participant Representative Present?

Yes No

Interpreter Used?

Yes No

B — Welcome and Introduction to OCC

Item	Done ☐	Date	Initials
Welcomed participant and representative to OCC; introductions made
Explained OCC's mission, values, and NDIS registration (NDIS provider 4-JU2I9UJ)
Provided OCC contact details: phone, email, and after-hours procedures
Explained how to identify OCC staff (ID cards, uniforms, expected conduct)
Introduced key OCC staff member(s) who will be regularly involved in their support

C — Participant Rights

Item	Done ☐	Date	Initials
Explained participant's rights under the NDIS Act 2013 and NDIS Code of Conduct
Explained the right to dignity, respect, and to be treated as an individual
Explained the right to make their own decisions, including the right to take reasonable risks
Explained the right to privacy and confidentiality of personal information
Explained the right to have an advocate or support person present at any time
Explained the right to access their own records held by OCC
Explained the right to make a complaint without fear of consequences
Explained the right to withdraw from OCC services at any time with notice
Participant was given a copy of the OCC Rights and Responsibilities Statement / Easy Read version (if applicable)

D — How Support is Delivered

Item	Done ☐	Date	Initials
Explained how the participant's NDIS plan goals inform their OCC Support Plan
Discussed the participant's preferred support style and communication preferences
Explained the rostering process — how shifts are allocated and communicated
Explained what to expect if a regular worker is unavailable (backup cover process)
Explained OCC's approach to introducing new workers to the participant
Discussed participant's daily routine preferences and any significant boundaries
Explained the Support Plan review process and how the participant can request changes

E — Safety and Emergency Procedures

Item	Done ☐	Date	Initials
Explained what to do in an emergency (call 000 first; then notify OCC)
Verified that participant has a Personal Emergency Plan (or arrangements to develop one)
Explained OCC's approach to safe environments and hazard identification
Discussed any participant-specific safety risks and the strategies in place
Confirmed participant knows how to contact their Emergency Contact
Explained what happens if a participant does not answer the door / cannot be located

F — Incidents, Feedback, and Complaints

Item	Done ☐	Date	Initials
Explained what constitutes a reportable incident under the NDIS (NDIS Act s.73Z)
Explained how OCC responds to incidents — support for participant, investigation, notification
Explained how to provide feedback — formal and informal pathways
Explained the OCC complaints process (OCC Complaints Policy + NDIS Commission)
Provided NDIS Commission contact: 1800 035 544 \| ndiscommission.gov.au
Explained participant can also contact the NDIS Quality and Safeguards Commission independently
Confirmed participant is aware of advocacy services available (e.g. Disability Advocacy Network)

G — Documentation and Privacy

Item	Done ☐	Date	Initials
Explained what records OCC keeps about the participant and why
Explained how participant information is stored, accessed, and protected
Explained OCC's obligations under the Privacy Act 1988 (Cth)
Confirmed participant has signed or will sign the OCC Privacy Consent Form
Explained that shift notes are written after each support session — participant can request to see notes
Explained photo and social media policy — no images without explicit consent

H — Consents and Agreements Completed

Document	Signed ☐	Date	Filed ☐
Service Agreement signed
Participant Information & Consent Form signed
Privacy Statement provided and acknowledged
Support Plan developed and agreed
Individual Risk Profile Assessment completed
Personal Emergency Preparation Plan completed
Medication Plan & Consent completed (if applicable)
Behaviour Support Plan received / acknowledged (if applicable)

Step 3 of 6

Step 5 — Participant Consent Form

PT-CON-001 | V2.0 | NDIS Practice Standards 1.3, 1.5, 1.8 | Privacy Act 1988 (Cth)

This form must be completed for every participant at or before commencement of services. It consolidates Participant Information & Consent, Telehealth Consent, and Third Party Information Release into one signing session. Review and re-sign annually or when participant circumstances change. File in 02_Consent_Forms.

If a participant lacks decision-making capacity, a Nominee, Legal Guardian, or Advocate must sign on their behalf. Authority to Act as Advocate (PT-ATA-001) MUST be on file before services commence.

Section E — Your Specific Consents

Please indicate YES or NO for each item below. You may say YES to some and NO to others. Your access to OCC supports will NOT be affected by which items you consent to. You may change any consent at any time by notifying OCC in writing.

# Consent Item	YES	NO
1. Sharing my personal and support information with OCC staff who deliver my services	YES	NO
2. Sharing relevant information with my NDIS Support Coordinator to plan and coordinate my supports	YES	NO
3. Sharing service delivery information with my Plan Manager for invoicing and budget management	YES	NO
4. Sharing relevant clinical / health information with my GP or healthcare providers (verbal consent also sought at time of need)	YES	NO
5. Sharing information with my nominated family member(s) and carer(s) listed in my Intake Form	YES	NO
6. Sharing service information with other disability service providers I also use	YES	NO
7. Taking photos or short videos for the purpose of progress monitoring and care planning (stored securely — never published without a separate media consent)	YES	NO
8. Using fully anonymous, de-identified information about my supports for OCC quality improvement and staff training purposes	YES	NO
9. Contacting me by phone or email to seek feedback about my support experience	YES	NO
10. Emergency medical treatment or decisions on my behalf if I am unable to respond and an emergency contact cannot be reached in time	YES	NO

Section F — Third Party Information Release (complete if applicable)

Third Party Full Name

Relationship to Participant

Organisation (if applicable)

Contact Number / Email

Purpose of Information Sharing

Duration of Consent

Until revoked in writing Until date:

Section G — Telehealth Consent (complete if telehealth services will be used)

OCC staff collect and record personal information relevant to your situation as part of telehealth service delivery. This is managed under the same privacy obligations as in-person services.
You are responsible for the costs of your own device and internet connection. You need a device with camera, microphone, speakers, and a private quiet space.
Your privacy over the internet may be limited by the security of your own technology. Audio or video recordings will only occur with your explicit verbal consent at the start of each session.
I agree to receive services via telehealth and understand I may agree to or refuse any telehealth session at any time without affecting my access to in-person supports.

Section H — Declaration and Signature

Do not sign this form unless you have read it (or had it read to you) and understand what you are consenting to. Ask for an interpreter, Easy Read version, or an advocate if needed before signing.

Participant Full Name

NDIS Number

Date of Birth

Signing as

Participant (self) Nominee Legal Guardian Advocate

Signature - Consent & Declaration

Date Signed

Step 5 of 6

Legal Entity	Open Care Community Services Pty Ltd
Trading As	Open Care Connect (OCC)
ABN	22 668 873 694
NDIS Registration	4-JU2I9UJ
Privacy Contact	admin@opencareconnect.com.au

Service Provider	Open Care Community Services Pty Ltd t/a Open Care Connect · ABN: 22 668 873 694 · NDIS: 4-JU2I9UJ · 32 Ranfurlie Circuit, Melton West VIC 3338
Participant