NDIS consent form for sole trader support workers – SAMPLE

As a support worker, you will often need to collect and share information with others about the person you support. To be able to do this, you will need their consent. Without the persons consent, you are potentially breaking the law.

A Consent Form is an essential agreement that should be in place with your NDIS participant before you request or disclose any information about them. The below sample consent form has been developed as a guide to assist you. Like your Service Agreement, you should research and develop a consent form that suits your business and service provisions.

Sample Consent Form:

NDIS Consent to Collect and Share Information

Your personal information and the law

In Australia, personal information is protected by strict privacy rules. They are called the Australian Privacy Principals and they form part of the Privacy Act 1988.

Under this privacy legislation, You have the right to know how Your personal information is collected, stored, accessed, used, and disposed of. This includes knowing and understanding when Your personal information can be shared with someone else.

To provide You with high quality and safe services, sometimes I need to collect and use some of Your personal information. To do this I require Your consent.  When You engage My services, I will ask You to give Your consent, usually in writing. I will explain to You why I need to keep some of Your personal information, what I will do with it, and how I will store it, so it stays private and confidential.

What is Your personal information used for when it is collected by Me?

I need certain personal information about You to:

  • work with You in the context of Your NDIS plan, budgets, and goals,
  • understand what You want and need from Me, and sometimes others, to provide You with quality and safe services.
When is Your consent required by Me?

When Your personal information is requested by any other person, service, or agency, I require Your consent to share; expect where the Law otherwise allows.

Can You choose not to give Your consent?

You can decline to give consent, or to limit Your consent. If You do, it may be difficult for Me to provide the services that You need and want from Me. Having relevant and important information about You to do My job well is important. It directly affects the quality and safety of the services I provide to You.

When is Your consent not required by Me to share Your personal information?

There are certain circumstances under the law where I must disclose information about You even if I do not have Your consent. This might include times when mandatory reporting is required, or when I am obligated to report incidents (or suspected incidents) of violence, exploitation, neglect, abuse, and sexual misconduct to the NDIS Commission and police.

Ensuring the safety of children is an important role of government and services too. If I have concerns about a child’s safety, welfare, or wellbeing, I may be legally obligated to disclose information about this without parental consent. I am permitted to do so under Chapter 16A of the Children and Young Persons (Care and Protection) Act 1998.

If You need any further information or have any questions or concerns about the collection and use of Your personal information You can discuss this with Me. Your personal information is protected under the National Disability Insurance Scheme Act 2013 and the Privacy Act 1988.

Making a complaint about the missus of your personal information

Your personal information is protected under the National Disability Insurance Scheme Act 2013 and the Privacy Act 1988. If You know or believe that Your personal information has been collected, stored, accessed, used, and disposed of inappropriately, You can make a privacy complaint via the Office of the Australian Information Commissioner.

Consent to collect and share personal information

You, insert participant or authorised participant representatives name, voluntarily provide consent to Me, insert support workers name to collect and/or share Your personal information with the people, services, and agencies named below for the purposes of providing Your services and support as outlines in our Service Agreement.

You understand that Your consent will continue until I insert support workers name receive advice in writing or verbally that You withdraw Your consent. 

Your/Your Authorised Representatives Signature:_____________________________________________     Date: _____________________________

Or, where You are unable to provide written consent, You provide:      

Verbal consent to collect and share personal information

Participant / Authorised Participant Representatives name was not able to provider written consent. I, Workers name, have explained the contents of this form to Participant / Authorised Participant Representative, including that this consent will continue to be in effect until they formally advises me otherwise.  I am satisfied that they understand the contents and have given their consent voluntarily.

My Signature:_____________________________________________     Date: ___________________________

Witnesses Name:_____________________________________________     (where applicable)

Witnesses Signature:_____________________________________________     Date: ___________________________