Incident report template for disability and aged care providers
A structured incident report template that captures everything NDIS and Aged Care Quality and Safety Commission standards require, in plain language.
How to use this template
Complete this form as soon as possible after an incident occurs — ideally on the same day. Prompt, accurate documentation is the foundation of good incident management and your best protection in any subsequent review or complaint.
This template covers the information required under NDIS Practice Standards and Aged Care Quality Standards. For incidents that require NDIS Commission notification, complete this template first, then use the Commission's online notification portal.
Incident Report
Report reference: (auto-assigned by your system, or use a sequential number)
Date of report:
Name of person completing report:
Role:
Section 1: Incident details
Date of incident:
Time of incident (approximate is acceptable):
Location: (client's home / community location / organisation premises)
Exact address or location description:
Section 2: People involved
Participant/client name:
Participant/client NDIS number (if applicable):
Support worker/carer name:
Other people present: (names and roles)
Was the participant's emergency contact/family/guardian notified? Yes / No
If yes, name of person notified and time of notification:
Section 3: Description of the incident
Describe what happened in factual, specific terms. Include what you directly observed. Avoid interpretation or opinion.
(What happened? What did you see, hear, or observe? In what sequence did events occur?)
Section 4: Type of incident
Select all that apply:
- Physical injury to participant
- Physical injury to worker or other person
- Psychological harm to participant
- Medication error
- Missing person / elopement
- Restrictive practice incident
- Abuse or neglect (actual or alleged)
- Financial exploitation (actual or alleged)
- Property damage
- Near-miss (potential incident that did not result in harm)
- Other:
Section 5: Severity classification
- Minor — No significant injury or harm. No immediate risk. Managed on the day.
- Moderate — Injury or harm requiring medical attention or significant organisational response.
- Serious — Significant harm, hospitalisation, or incident requiring NDIS Commission / regulator notification.
Note: When in doubt, classify upward. Reclassify after review if appropriate.
Section 6: Immediate actions taken
(What was done immediately in response to the incident? Who was called? What first aid or care was provided? What was said to the participant?)
Section 7: Was emergency services contacted?
Time called:
- Yes — Police / Ambulance / Fire:
- No
Section 8: Supervisor/coordinator notification
Name of supervisor/coordinator notified:
Time of notification:
Method of notification: (phone / in person / message)
Section 9: NDIS Commission notification required?
Under NDIS (Incident Management and Reportable Incidents) Rules 2018, certain incidents must be reported to the NDIS Commission within 24 hours (serious incidents) or within 5 days (other reportable incidents).
- Yes — Commission notification required
- No — does not meet reportable incident threshold
- Under review — escalate to [responsible role] by:
Section 10: Follow-up required
(What needs to happen next? Who is responsible? By when?)
| Action | Responsible person | Due date | Completed |
|---|---|---|---|
Section 11: Root cause / contributing factors
(To be completed by supervisor or quality lead, within 5 business days for moderate or serious incidents)
What factors contributed to this incident occurring?
What could be done differently to prevent recurrence?
Sign-off
Completed by:
Date:
Reviewed by (supervisor/manager):
Date of review:
Outcome of review:
- No further action required
- Action plan in progress (see Section 10)
- Referred to quality/risk management
- External notification required (Commission, insurer, other)
Notes on retention and storage
Incident reports must be retained for a minimum of seven years (or until a minor reaches the age of 25, whichever is later) under Australian healthcare records legislation. Store in a secure system with access limited to appropriate staff.
If you are using paper records, store in a locked filing system. If electronic, ensure access controls are in place.