Complete Choice

0414 890 464 / 0466 057 770

info@completechoice.com.au

39 John St, Salisbury, SA 5108

New Participant-Risk-Assessment

New Participant-Risk-Assessment-Revised correction

PARTICIPANT DETAILS

Participant Requirements / Preferences

Known Medical Conditions or Allergies

Emergency Contacts

CARER / GUARDIAN DETAILS

Persons Involved in Risk Assessment

Was the participant involved in the assessment?

Daily Personal Activities – including participants living alone

Support Worker

Information Sharing and Privacy

Privacy Policy Explained
Sharing information

STEP 1. IDENTIFY RISKS

Tick all
applicable risks

Personal Contact
Physical Mobility
Communication

Note: If supports will be delivered by sole support worker, and any of the above risks apply, a
Monitoring and Supervision Plan must be created.

Medical conditions and interventions

Personal care

Personal Care
Eating and drinking
Accidental movement
Manual handling
Environmental risks
Mental health and wellbeing
Financial risks
Social risks
Substance use

STEP 2. ADDRESS RISKS IDENTIFIED IN STEP 1

RISK MANAGEMENT PLAN (See APPENDIX for Consequence Rating Table and
Example Risk Management Plan)

Type of Risk Likely Effect Level  Risk Treatment Person Responsible Review Date
Participant Others

AUTHORISATION

Maximum file size: 5MB

Maximum file size: 5MB

Copy Supplied to participant.
Copy placed on participant's file.

DAILY PERSONAL ACTIVITIES SUPPORT WORKER

SUPPORT WORKER DETAILS – Complete where services provided by
support worker

SELECTION CRITERIA

Worker Suitability
Participant Requirements / Preferences
Worker Competencies

WORKER REPORTS SUBMITTED TO*

MONITORING AND SUPERVISION PLAN

Risk Monitoring and Supervision – Participants Living Alone – Support
Worker

Risk Monitoring and Supervision – Participants Living Alone – Support  

Worker 

Participant Risk*  Monitoring Types and Frequencies 
Identified  Risk  Commen Risk  

Leve 

Communication with  

participant* 

Worker  

Reports 

On-site  

Monitoring

On-site  

Supervisio

Other  

Supervisio n * 

Feedback  In 

person 

Other  

(specify 

E.g.:  

Infection

Has  

history of  infection 

High  Quarterl 

y survey 

6  

monthl 

y

phone  

monthly

Twice  

weekly - 

Mon &  

Thurs 

Every 2  

Months 

6 monthly  Fortnightly  by phone 
E.g.  

Needs  

assistanc 

e with  

mobility 

May be  

unable to  return to  chair/  

access  

phone 

Low  as above  as  

above 

as  

above 

Report  

incident 

s

as above  as above  as above 

COMMUNICATION WITH OTHER PROVIDERS

Information Sharing and Privacy
Ensure that the Privacy Policy has been explained and the participant has consented to share information (page
2).

Provider 1

Provider 2

AUTHORISATION (MONITORING AND SUPERVISION PLAN)

AUTHORISATION

Maximum file size: 12MB

Maximum file size: 70MB