NDIS Incident Report — 360SC Tools

📋 Report Details

Report Number

Date Report Completed

Reporting Person (Name)

Role / Position

Organisation

Your Phone / Email

👤 Participant Involved

Participant Name

NDIS Number

Participant Date of Birth

Participant Phone

Guardian / Nominee / Emergency Contact

📍 Incident Details

Date of Incident

Time of Incident

Location of Incident

Incident Type

Severity

Describe What Happened (factual, chronological account)

Immediate Action Taken

👥 Others Involved

Were any other participants, workers, or third parties involved? Provide names and roles.

Were there any witnesses? Names and contact details.

📢 Reporting Obligations

Under the NDIS (Incident Management and Reportable Incidents) Rules 2018, certain incidents must be reported to the NDIS Commission.

Is this a Reportable Incident?

NDIS Commission Notified?

Notification Date / Reference

Police Notified?

Reportable Incidents include: unexpected death · serious injury · abuse or neglect · unauthorised restrictive practices · sexual misconduct involving a worker · emergency police response. Report within 24 hours (critical) or 5 days (other reportable). Call NDIS Commission: 1800 035 544

NDIS Incident Report Form

📋 Report Details

👤 Participant Involved

📍 Incident Details

👥 Others Involved

📢 Reporting Obligations

🔍 Investigation & Follow-Up