Forms

Incident Report

Leave Request

Employee Availability Form

Feedback & Complaints Form

Incident Report PDF (print, fill, scan & email)

Or submit the form below

Incident Report

Please Select

Date

Name

Phone

Position

Incident Details

Incident relates to:

Date of Incident

Time of Incident

Hours

Minutes

Location of Incident

Type of Incident

Details of incident

Details of injury

Action takenApplied first aidContacted Team Leader or Case ManagerCalled emergency servicesPerson requested no action to be taken

Was medical treatment required

Has this incident been reported to a supervisor

Name

Position

Were emergency services calledYesNo

If yes, which emergency services were calledAmbulanceFirePolice

Other

Upload file if required

No file chosen

Acknowledgement *

I acknowledge that all information included in this incident report is true and correct.

Leave Request PDF (Print, Fill, Scan & Email)

Or submit the form below

Employee Leave Request

Date

Name

Leave Start Date

Leave Return Date

Type of leave requested

Other (Please explain)

Acknowledgement *

I understand that this leave request is subject to approval by my employer.

Employee Availability PDF (Print, Fill, Scan & Email)

Or submit the form below

Employee Availability Form

Use this form to update your availability if your circumstances change

Date

Name

Monday (Week 1)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Tuesday (Week 1)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Wednesday (Week 1)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Thursday (Week 1)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Friday (Week 1)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Saturday (Week 1)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Sunday (Week 1)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Monday (Week 2)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Tuesday (Week 2)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Wednesday (Week 2)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Thursday (Week 2)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Friday (Week 2)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Saturday (Week 2)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Sunday (Week 2)Available whole dayAvailable for SleepoverUnavailable whole day

Time available from

Time available to

Feedback & Complaints PDF (Print, fill, Scan & email)

Or submit the form below

Feedback and Complaints Form

Empowering You Disability Services is committed to continually improving services so as to ensure person's with disabilities, their families, carers and friends receive positive and meaningful support. We conceive all feedback and complaints, not excluding personal insight, to be valuable and essential to setting the standards of high quality support.

Please select one of the options below

Do you wish to remain anonymous?Empowering You Disability Services promotes choice and control of all people, therefore respects the decision to remain anonymous when providing feedback or making a complaint.

NameIf you answered 'no' above, please state your name and details.

Phone

Email Address

What occurred to prompt the feedback or complaint?Please give details including dates/times where necessary.

Please attach any additional information or supporting documents.

No file chosen

What outcome is being sought in response to providing this feedback or making a complaint?

Do you wish to receive progress reports?

Privacy Information

Empowering You Disability Services is committed to protecting your privacy. We collect and handle personal information that you provide on this form for investigating and responding to your feedback or complaint. We will only use your information in accordance with relevant privacy and other laws. For us to provide the best possible service, we may need to share your personal information with stakeholders, such as NDIS Safety & Quality Commission. If you submit complimentary feedback, it may be used and published to promote our services and supports. No personal or identifying information will be published. We are unable to respond to anonymous feedback and complaints.

Acknowledgement *

I declare the information I have provided is true and correct.