Participant Review Form

Territory Disability Service

Review Details

People present at review Date Client Name Staff Member Name Also present

Review of Support Plan

Goals achieved Actions that helped me Actions that didn’t help Goals not achieved Next Support Plan – repeat these goals and actions Next Support Plan – try these new goals and actions

Risks and Risk Treatments

Incidents and accidents Risk treatments that worked Risk treatments that didn’t work Risk treatments to continue Risk treatments to discontinue New risk treatments New risks identified New treatment New risk/s and risk treatment/s added to Client Risk Assessment

Supporter Involvement

I am happy with my supporters’ current level of involvement I would like to increase my supporters’ level of involvement I would like to decrease my supporters’ level of involvement How I want to change my supporters’ involvement Who can help me achieve this? Goals to add to Support Plan

Access to My Chosen Community

I am happy with my current level of involvement in my community I would like to increase my level of involvement in my community I would like to decrease my level of involvement in my community How I want to change my involvement in my community Who can help me achieve this? Goals to add to Support Plan

Feedback

Client Feedback Supporter Feedback

Review Sign-off

Signature of staff member Date Date of next review

Review Provided To

Name/s

Consent Obtained

Client Yes N/A Family / Carer Yes N/A Other Staff Yes N/A Other Service Provider Yes N/A

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