SYW Support Plan

Welcome to your support plan!

Your plan will include important personal and safety information about you and your working environment. Your plan will be made available to support workers as you bring them onto a shift.

Please include as much detailed information as possible so that your workers will be well prepared to provide you with the best possible support. If you do not want to include too much detail, that's okay too!

If you would like assistance filling out this support plan, please contact Luke David at luke@supportyourway.com.au or on 0424 160 174.

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* 1. Are you the person receiving care or support?

Yes

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* 2. If no to the above question, what is your relationship to the person receiving our support services?

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* 3. Contact details of the person receiving support services:

First Name

Last Name

Gender

Mobile Number

Birth Date

Full Residential Address

NDIS Number

NDIS Plan Dates

Primary Disability

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* 4. Interests / Hobbies / Loves

Cooking

Movies

Animals

Sports

Gardening

Music

Art / Photography

Travelling

Games / Puzzles

Cultural Festivals

Reading

List as many other Interests / Hobbies / Loves you may have!

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* 5. First Language

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* 6. Second Language (Optional)

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* 7. Cultural Background Details (Optional)

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* 8. Religion Details (Optional)

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* 9. On average, how much one-on-one support do you need each week?

We understand that support needs will be different every day or week. There are no upfront fees, obligations or lock-in terms with Support Your Way, and you can book as few or as many hours of support as you like.

0 - 5 hours

6 - 10 hours

11 - 15 hours

16 - 20 hours

21 - 25 hours

26 - 30 hours

30+ hours

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* 10. What support areas are you looking for?

Cleaning / Gardening

Home Care

Personal Care

Social Activities & Community Access

Education, Training or Employment

Therapy Support

Transport

Support Coordination

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* 11. Do you require support or assistance with mobility?

Yes

Please describe your ability to move around independently. Include information such as your ability to walk, take stairs, use of walking aids/wheelchairs, your ability to transfer etc.

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* 12. Do you require support or assistance with information (cognitive) processing?

Yes

Please describe the way you understand and process information, your skills when it comes to thinking and reasoning, the strength of your memory (short and long term), and your self-awareness, awareness of others and what's going on around you.

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* 13. Do you require support or assistance with communication?

Yes

Please describe how you communicate. What are your strengths/weaknesses (in speaking, listening, reading, writing)? Are there any specific techniques or methods that your support worker should know?

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* 14. Are there any behaviours that your support worker should be aware of?

Yes

Please describe the behaviours and the impact they may have on you and others. Please go into detail about any management techniques your support worker could employ to help in the event that they are necessary (including behavioural plans).

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* 15. Do you require personal care during a shift?

Yes

What type of personal care do you require? (Showering, toileting, dressing etc.)

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* 16. Do you require any mealtime assistance?

Yes

Please describe any considerations when preparing food or feeding.

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* 17. Do you have any personal goals that you would like to share with your support worker?

Yes

Please list your goals and describe the support you will need from your support worker in achieving them.

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* 18. In addition to the above, are there any specific tasks and duties that will be required of your support worker?

Yes

What tasks and duties will be required of your support worker? (Cleaning, transport etc)

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* 19. Do you have a gender preference for who supports you?

Female

Male

No preference

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* 20. Are you at risk of choking, seizures or anaphylaxis?

Yes

Please provide details, including any specific instructions for your support worker on how best to respond.

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* 21. Do you have any other allergies?

Yes

Please provide information about your allergies, including any specific instructions for your support worker on how best to respond.

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* 22. Will your support workers be required to administer medication?

Yes

Please provide details, including any specific medications, instructions on the correct procedure, or other information that your support worker should be aware of.

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* 23. Please detail any other considerations or instructions you would like to share with your support worker, which could include phobias or specific conditions.

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* 24. Is your home difficult to locate?

Yes

Please provide details, this could include information about gates, driveways or the kind of building you live in (Unit or apartment, for example)

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* 25. Is parking available for your support worker?

Yes

Please provide instructions that could help your support worker find a park at your home or information about nearby car parks or complexes.

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* 26. Are any gates or doorways difficult to use or access?

Yes

Please provide instructions to assist your support worker with opening gates and doorways. This could include whether your latch is rusty or there is a code on your lock.

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* 27. At night, is the house entrance hard to find?

Yes

Details

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* 28. Are there any slip, trip or falling hazards outside your home?

Yes

Please provide details, this could include stairs being slippery when wet, uneven driveway or garden surfaces, toys or garden equipment.

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* 29. Is your home wheelchair accessible?

Yes

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* 30. Are there any slip, trip or falling hazards inside your home?

Yes

Details

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* 31. Will your support worker be required to use any electrical appliances?

Yes

Details

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* 32. Is there anything your support worker need to know about your pets?

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* 33. In case of an emergency in the home, please describe the emergency procedure for your support worker to follow. Please consider any special procedures, nearest exits and emergency meeting points.

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* 34. Is there anything else you'd like to share about your home?

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* 35. Safety checklist

By engaging workers in the home environment, it is your responsibility to ensure certain safety requirements. Please tick to acknowledge that:

Electrical appliances and power cords are in good working order.

Power cords are attached to power boards and power sockets, and not double adaptors.

The house is fitted with working smoke alarms.

The fuse box is fitted with a safety switch.

Support workers will not be exposed to cigarette smoke in the home.

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* 36. Are there any places, situations or specific irritants that should be avoided?

Yes

Details

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* 37. If something were to go wrong in the community, are there any specific emergency instructions for your support worker?

Yes

Please provide instructions for your support worker on how best to respond.

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* 38. What type of transport will you use?

Public transport

Using my car (with the support worker driving)

Using your support worker's car

Other (please specify)

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* 39. If you are using your support worker's car for transport, what is the maximum amount of kilometres you would like to use per support service?

0 - 10

10 - 20

30 - 40

40 - 50

Please provide details.

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* 40. Are there any specific risks associated with transport?

Yes

Please provide details.

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* 41. If something were to go wrong, are there any transport-specific emergency instructions for your support worker?

Yes

Please provide instructions for your support worker on how best to respond.

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* 42. In case of emergency, who should we contact?

First name and last name

Mobile number

Home phone number

Email address

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* 43. How will you be paying for services through Support Your Way?

If you are self-managed or plan-managed, we'll send you an invoice with our payment details at the end of each fortnight.

I will pay by bank transfer/EFT (Self Managed)

Another party manages my funding (Plan Managed)

The NDIA manages my funding (NDIA Managed)

Please list your Fund Manager or if you would like your invoice to be sent to a third party.

SYW Support Plan

Welcome to your support plan!

Question Title

* 1. Are you the person receiving care or support?

Question Title

* 2. If no to the above question, what is your relationship to the person receiving our support services?

Question Title

* 3. Contact details of the person receiving support services:

Question Title

* 4. Interests / Hobbies / Loves

Question Title

* 5. First Language

Question Title

* 6. Second Language (Optional)

Question Title

* 7. Cultural Background Details (Optional)

Question Title

* 8. Religion Details (Optional)

Question Title

* 9. On average, how much one-on-one support do you need each week?We understand that support needs will be different every day or week. There are no upfront fees, obligations or lock-in terms with Support Your Way, and you can book as few or as many hours of support as you like.

Question Title

* 10. What support areas are you looking for?

Question Title

* 11. Do you require support or assistance with mobility?

Question Title

* 12. Do you require support or assistance with information (cognitive) processing?

Question Title

* 13. Do you require support or assistance with communication?

Question Title

* 14. Are there any behaviours that your support worker should be aware of?

Question Title

* 15. Do you require personal care during a shift?

Question Title

* 16. Do you require any mealtime assistance?

Question Title

* 17. Do you have any personal goals that you would like to share with your support worker?

Question Title

* 18. In addition to the above, are there any specific tasks and duties that will be required of your support worker?

Question Title

* 19. Do you have a gender preference for who supports you?

Question Title

* 20. Are you at risk of choking, seizures or anaphylaxis?

Question Title

* 21. Do you have any other allergies?

Question Title

* 22. Will your support workers be required to administer medication?

Question Title

* 23. Please detail any other considerations or instructions you would like to share with your support worker, which could include phobias or specific conditions.

Question Title

* 24. Is your home difficult to locate?

Question Title

* 25. Is parking available for your support worker?

Question Title

* 26. Are any gates or doorways difficult to use or access?

Question Title

* 27. At night, is the house entrance hard to find?

Question Title

* 28. Are there any slip, trip or falling hazards outside your home?﻿

Question Title

* 29. Is your home wheelchair accessible?

Question Title

* 30. Are there any slip, trip or falling hazards inside your home?

Question Title

* 31. Will your support worker be required to use any electrical appliances?

Question Title

* 32. Is there anything your support worker need to know about your pets?

Question Title

* 33. In case of an emergency in the home, please describe the emergency procedure for your support worker to follow. Please consider any special procedures, nearest exits and emergency meeting points.

Question Title

* 34. Is there anything else you'd like to share about your home?

Question Title

* 35. Safety checklist By engaging workers in the home environment, it is your responsibility to ensure certain safety requirements. Please tick to acknowledge that:

Question Title

* 36. Are there any places, situations or specific irritants that should be avoided?

Question Title

* 37. If something were to go wrong in the community, are there any specific emergency instructions for your support worker?

Question Title

* 38. What type of transport will you use?

Question Title

* 39. If you are using your support worker's car for transport, what is the maximum amount of kilometres you would like to use per support service?

* 9. On average, how much one-on-one support do you need each week?

We understand that support needs will be different every day or week. There are no upfront fees, obligations or lock-in terms with Support Your Way, and you can book as few or as many hours of support as you like.

* 28. Are there any slip, trip or falling hazards outside your home?

* 35. Safety checklist

By engaging workers in the home environment, it is your responsibility to ensure certain safety requirements. Please tick to acknowledge that:

* 43. How will you be paying for services through Support Your Way?

If you are self-managed or plan-managed, we'll send you an invoice with our payment details at the end of each fortnight.