Complete Choice

0414 890 464 / 0466 057 770

info@completechoice.com.au

39 John St, Salisbury, SA 5108

F28 A NDIS Service Agreement Participant & Provider_2022

F28 A NDIS Service Agreement Participant & Provider_2022

Participant Service Agreement

Section

Contents
AGREEMENT ....................................................................................................................................... 3
1. Parties ...................................................................................................................................... 3
2. The NDIS and this Service Agreement ................................................................................... 4
3. Schedule of supports ............................................................................................................... 4
4. Responsibilities of the provider............................................................................................... 5
5. Responsibilities of the participant/participant’s representative .............................................. 6
6. Emergency or Disaster Arrangment ........................................................................................ 7
7. Payments ................................................................................................................................. 7
8. Changes to this Service Agreement ........................................................................................ 8
9. Ending this Service Agreement ............................................................................................... 8
10. Feedback, complaints and disputes ..................................................................................... 9
11. Goods and Services Tax (GST) ........................................................................................... 9
12. Contact details ..................................................................................................................... 9
13. Agreement signatures ........................................................................................................ 12
Copy of participant’s NDIS plan .................................................................................................. 12
SERVICE AGREEMENT
NOTE: A Service Agreement can be made between a participant and a provider or a participant’s
representative and a provider. A participant’s representative is someone close to the participant, such as a
family member or friend or someone who manages the funding for supports under a participant’s NDIS
plan.
NOTE: A Service Agreement can be made between a participant and a provider or a participant’s
representative and a provider.
A participant’s representative is someone close to the participant, such as a family member or friend or
someone who manages the funding for supports under a participant’s NDIS plan.

Checklist:

Has the participant been offered a copy of the signed and dated service agreement?
If the participant is unable to sign the agreement, has a file note been recorded as evidence of agreement to service?

Remember to use the participant onboarding checklist to ensure all rights and
responsibilities have been explained to the participant and /or their carer.

This Service Agreement is for

a participant in the National Disability Insurance Scheme and is made between:

1. The NDIS and this Service Agreement
(a) This Agreement is made according to the rules and the goals of the National Disability Insurance
Scheme (NDIS).
(b) A copy of the participant’s NDIS plan is attached to this Service Agreement [delete this sentence if
participant chooses not to attach their plan].
(c) The participant and the service provider agree that this Agreement is in line with the main ideas of the
NDIS. These ideas include things like having more choices, achieving your goals and taking part in the
community.
(d) The parties agree that this Service Agreement is made in the context of the NDIS, which is a scheme
that aims to:
• support the independence and social and economic participation of people with disability, and
• enable people with a disability to exercise choice and control in the pursuit of their goals and the
planning and delivery of their supports.
2. Schedule of supports
The provider agrees to provide the participant [insert description of supports] for [insert duration of each of
the supports provided].
(a) how they will be provided (b)
when they will be provided (c)
who will provide them?
(d) how long they will be provided for (e)
how much they will cost.
The supports and their prices are set out in the attached Schedule of Supports. All prices are GST inclusive
(if applicable) and include the cost of providing the supports.
Additional expenses (i.e. things that are not included as part of a Participant’s NDIS supports) are the
responsibility of the [participant / participant’s representative] and are not included in the cost of the
supports. Examples include entrance fees, event tickets, meals, laundry products, creams etc. 3.
Responsibilities of the provider
The provider agrees to:
(a) Review the provision of supports at least annually as per the practice standards with the participant
and any person they wish to include.
(b) To ensure that any staff member servicing a participant is easily identifiable as a staff member of
Complete Choice
(c) Once agreed, provide supports that meet the participant’s needs at the participant’s preferred times.
(d) Communicate openly and honestly in a timely manner.
(e) Treat the participant with courtesy and respect adhering to the NDIS Code of Conduct and the (insert
organisation name) general Code of Conduct.
(f) Consult the participant on decisions about how supports are provided.
(g) Provide the supports that meet your needs at the preferred times.
(h) Where participant’s needs change, respond in a timely manner to ensure care and support are aligned
with the needs and goals of the participant.
(i) Ensure information about managing any complaints or disagreements and details of the provider’s
cancellation policy (if relevant) is provided at admission.
(j) Listen to the participant’s feedback and resolve problems quickly.
(k) Give the participant a minimum of 24 hours’ notice if the provider must change a scheduled
appointment to provide supports.

(l) Where service interruptions are unavoidable, ensure the participant and/or their carer are contacted,
collaborated with to decide on alternative arrangements and that changes do not detract from the
quality of the service being received.
(m) Keep personal information private and respect personal privacy of participant.
(n) Keep you safe and ensure the safety of others.
(o) Give the participant the required notice if the provider needs to end the Service Agreement (see
‘Ending this Service Agreement’ below for more information)
(p) Provide supports in a manner consistent with all relevant laws, including the National Disability
Insurance Scheme Act 2013 and rules, and the Australian Consumer Law; keep accurate records on the
supports provided to the participant
(q) Issue regular invoices and statements of the supports delivered to the participant.
(r) Provide child/young person and their family, access to information collected about them, ensure it is
accessible on request and that all information is kept up to date.
(s) Employ a NIL tolerance to abuse, neglect, violence, exploitation and discrimation.

NDIS Welcome Package Provided?
NDIS Participant Induction Checklist completed

3.1 Responsibilities of the provider where servicing participants in a shared living environment, either
Supported Independent Living or a Specialised Disability Accommodation Dwelling.

Provider to select the situation(s) which apply:

4. Responsibilities of the participant/participant’s representative

The participant/participant’s representative agrees to:
(a) Respect the rights of staff, ensuring their workplace is safe and healthy and free from harassment.
(b) Advise us when there is an update to phone number, carer addresses or contact details, changes in your
health or situation.
(c) Abide by the terms of your agreement with us.
(d) Understand that your needs may change and with this, your services may need to change to meet your
needs
(e) Accept responsibility for your own actions and choices even though some choices may involve risk.
(f) Tell us if you have problems with the care and services you are receiving.
(g) Give us enough information to develop, deliver and review your support plan.
(h) Care for your own health and wellbeing as much as you are able.
(i) Provide us with information that will help us better meet your needs.
(j) Provide us with a minimum of 24 hours’ notice when you will not be home for your service.
(k) Be aware that our staff are only authorised to perform the agreed number of hours and tasks outlined in
your service agreement.
(l) Participate in safety assessments of your home or the place ‘of service’. (m) Ensure pets are controlled
during service provision.
(n) Provide a smoke-free working environment and understand if a work environment I deemed unsafe by
a worker or manager Complete Choice has the right to suspend services.
(o) Pay the agreed amount for the services provided with in the time frame stipulated.
(p) Tell us in writing (where able) and give us notice prior to the day you intend to stop receiving services
from us.
(q) To inform staff if you wish to opt out of audit.
(r) Inform the provider about how they wish the supports to be delivered to meet the participant’s needs
(s) Treat all staff with courtesy and respect.
(t) Talk to the provider if the participant has any concerns about the supports being provided
(u) Give the provider a minimum of 24 hours’ notice if the participant cannot make a scheduled
appointment; and if the notice is not provided by then, the provider’s cancellation policy will apply (v)
Give the provider the required notice if the participant needs to end the Service Agreement (see
‘Ending this Service Agreement’ below for more information), and
(w) Let the provider know immediately if the participant’s NDIS plan is suspended or replaced by a new
NDIS plan or the participant stops being a participant in the NDIS.

5. Emergency or Disaster Arrangements

In the event of an emergency or disaster (including an infectious disease scenio), Complete Choice will need
to ensure the safety and wellbeing of all participants. For this Complete Choice is obliged to facilitate the
completion of an individualised Person Centre Emergency Preparedness Plan (PCEPP) to ensure that in the
event of an emergency we are ready to act and aware of your needs and preferences.

Have you completed the PCEPP?

6. Payments

The provider will seek payment for their provision of supports after the [participant / participant’s
representative] confirms satisfactory delivery.
The participant has chosen to self-manage the funding for NDIS supports provided under this Service
Agreement. After providing those supports, the provider will send the participant an invoice for those
supports for the participant to pay. The participant will pay the invoice by [specify cash / cheque / EFT]
within [insert reasonable time period, e.g. 7 days].
[AND / OR]
The participant’s Nominee manages the funding for supports provided under this Service Agreement. After
providing those supports, the provider will send the participant’s Nominee an invoice for those supports for
the participant’s Nominee to pay. The participant’s Nominee will pay the invoice by EFT] within. 7 days].
[AND / OR]
The participant has nominated the NDIA to manage the funding for supports provided under this Service
Agreement. After providing those supports, the provider will claim payment for those supports from the
NDIS
[AND / OR]

7. Changes to this Service Agreement

If changes to the supports or their delivery are required, the parties agree to discuss and review this Service
Agreement. The parties agree that any changes to this Service Agreement will be in writing, signed, and
dated by the parties.

A supply of supports under this Service Agreement is a supply of one or more reasonable and necessary
supports specified in the statement of supports included, under subsection 33(2) of the National Disability
Insurance Scheme Act 2013 (NDIS Act), in the participant’s NDIS Plan currently in effect under section 37
of the NDIS Act.

8. Ending this Service Agreement

Should either party wish to end this Service Agreement they must give one month notice
If either party seriously breaches this Service Agreement the requirement of notice will be waived.

9. Feedback, complaints and disputes

If the participant wishes to give the provider feedback, the participant can talk to 23 Kent Road Macdonald
Park SA 5121 Mobile 0466057770 Compliance Manager . 0414890464 Director
If the participant is not happy with the provision of supports and wishes to make a complaint, the participant
can talk to 23 Kent Road Macdonald Park SA 5121 0414890464 Director info@completechoice.com.au
If the participant is not satisfied or does not want to talk to this person, the participant can contact the
National Disability Insurance Scheme by calling 1800 035 544 , visiting one of their offices in person, or
visiting ndis.gov.au for further information.

10. Goods and Services Tax (GST)

For the purposes of GST legislation, the Parties confirm that:

(a) a supply of supports under this Service Agreement is a supply of one or more of the reasonable and
necessary supports specified in the statement included, under subsection 33(2) of the National
Disability Insurance Scheme Act 2013 (NDIS Act), in the participant’s NDIS plan currently in effect
under section 37 of the NDIS Act;
(b) the participant’s NDIS plan is expected to remain in effect during the period the supports are provided;
and
(c) the [participant/participant’s representative] will immediately notify the provider if the participant’s
NDIS Plan is replaced by a new plan or the participant stops being a participant in the NDIS.

11. Contact details

The [participant/the participant’s representative] can be contacted on:

Contact details

The provider can be contacted on:

Contact details

Participant Rights & Responsibilities Audit Checklist

13. SERVICE AGREEMENT AUDIT CHECKLIST

What supports are being provided Yes or No Specifics

The supports I am receiving have been explained to me using an Easy Read document and/or by a staff member explaining this entire agreement.
I understand how the service will be provided?
I know when and where the support will be provided?

Proposed days and times?

Time

I am aware that when service times are changed this will be explained to me, and I will have the choice to accept or decline the new day or person?
I know whether this is a regular or one-off service?
The cost of service is provided in a Schedule of Support has been explained?
The breakdown of the costs has been explained to me.
The cost of materials and/or products has been explained to me (PPE, vehicle hire, building or furniture etc?)
I know where the cost of travel will be incurred such as; per km rates, hire of vehicle or STA?
I am clear where and how the travel cost will appear in an invoice?
If there are further fees and charges, such as risk assessments, referrals and consultation with other service providers; I am aware that this will be a fee that is added to the cost of service?

13. SERVICE AGREEMENT AUDIT CHECKLIST

I understand whether I need to pay Goods and Services Tax (GST) and which products are subject to GST.

Information about GST is available here

It has been explained to me, how the NDIS provider is paid for their service.
The cancellation policy has been explained to me.
I understand what my provider and I need to do before supports can be provided?
I know what my provider and I need to do if either of us can’t meet our responsibilities?
I have been offered a copy of the signed and completed service agreement?
I understand if I am unable to sign the agreement or don’t wish to sign it, the provider will make a note of this on my file.

About the service agreement

The service agreement is in a format and uses language I understand?
I know how long the service agreement goes for and it is clearly stated in the agreement?
I understand that I have the right to say how long the service agreement should be and that it does not have to be for the same length of my NDIS Plan, although it often can be?
I know when the service agreement will be reviewed
I understand how changes to the service agreement will be managed
I understand how to end the service agreement

Dispute resolution process

I know what to do if I am unhappy with a situation or service as the complaint and feedback process has been explained to me and I know I can contact the NDIS Commission should I need to?

13. SERVICE AGREEMENT AUDIT CHECKLIST

I know how I can raise any concerns or issues with this provider and have been provided with a document explaining this to me?
I know who to contact if an issue cannot be resolved or if I have a complaint?

12. Agreement signatures

The participant and/or their carer or representative agree that information will need to be collected to offer
person centred supports. A consent to share information form will also be offered and explained at the time
of onboarding. Only information that is necessary will be requested and at any time a participant can retract
any consents for information.
The parties agree to the terms and conditions of this Service Agreement and to follow the PCEPP in the
event of an emergency or disaster which carries with it the capacity to interrupt service delivery to the
participant:

Maximum file size: 15MB

Maximum file size: 15MB

Maximum file size: 50MB