Assessment and Management

This assessment is to be completed prior to visiting any Participant in their home. Staff are not permitted to conduct a home visit until staff have received approval and received your roster of visits.
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Participant name {{ $participantdata['name'] ?? '' }}
Address {{ $assessment_and_management['address'] ?? '' }}
Contact No {{ $assessment_and_management['phone'] ?? '' }}
Property Type {{ $assessment_and_management['property_type'] ?? '' }}
NDIS No {{ $assessment_and_management['ndis_number'] ?? '' }}
DOB {{ $participantDOB ?? '' }}
Support type {{ $assessment_and_management['support_type'] ?? '' }}
Legal Guardian {{ $assessment_and_management['legal_guardian'] ?? '' }}
Support Coordinator {{ $assessment_and_management['support_coordinator'] ?? '' }}
Diagnosis {{ $assessment_and_management['diagnosis'] ?? '' }}
Consent
Is the Participant/representative known about the Support organisation visit? {{ $assessment_and_management_data['is_the_participant_representative_known']['answer_1'] ?? '' }}
Has the Participant/representative/carers consented to the proposed visit? {{ $assessment_and_management_data['has_the_participant_representative_carers']['answer_1'] ?? '' }}
Is the Participant/representative/carers aware of the proposed visit? {{ $assessment_and_management_data['is_the_participant_representative_carers']['answer_1'] ?? '' }}
Has the Roster been discussed with the participant? {{ $assessment_and_management_data['has_the_roster_been_discussed']['answer_1'] ?? '' }}
Property access Assessment
Is the house clutter free and free to move? There is sufficient space to conduct the support activities. {{ $assessment_and_management_data['is_the_house_clutter']['answer_1'] ?? '' }}
Lighting/ ventilation is appropriate for the activities? {{ $assessment_and_management_data['lighting_ventilation']['answer_1'] ?? '' }}
Equipment is appropriated for the support requirements (microwave, roster, gas cook-top and other electrical equipment)? {{ $assessment_and_management_data['equipment_is_appropriated']['answer_1'] ?? '' }}
Is there any damage to the electrical equipment? (damaged plugs or sockets. or overloaded electrical sockets?) {{ $assessment_and_management_data['is_there_any_damage']['answer_1'] ?? '' }}
Will you have mobile phone coverage at the premises? {{ $assessment_and_management_data['will_you_have_mobile']['answer_1'] ?? '' }}
Is the house visible from the street? {{ $assessment_and_management_data['is_the_house_visible']['answer_1'] ?? '' }}
Is the premises easily accessible from the street? {{ $assessment_and_management_data['is_the_premises_easily']['answer_1'] ?? '' }}
Is off-street parking available? {{ $assessment_and_management_data['is_off_street_parking']['answer_1'] ?? '' }}
Is Participant able to open the door to give you access? {{ $assessment_and_management_data['is_participant_able']['answer_1'] ?? '' }}
How the staff will enter your house? {{ $assessment_and_management_data['how_the_staff_will_enter']['answer_1'] ?? '' }} Other {{ $assessment_and_management_data['how_the_staff_will_enter']['answer_2'] ?? '' }}
During the support hour, if you are not available, then what do you expect from the staff? {{ $assessment_and_management_data['during_the_support_hour']['answer_1'] ?? '' }} Other {{ $assessment_and_management_data['during_the_support_hour']['answer_2'] ?? '' }}
Is enough lighting in the house? {{ $assessment_and_management_data['is_enough_lighting']['answer_1'] ?? '' }}
Associated Risks Assessment
Are additional persons expected to be present at the time of the visit? {{ $assessment_and_management_data['are_additional_persons']['answer_1'] ?? '' }}
Is the Participant or others known to be potentially aggressive, violent, or disturbed? {{ $assessment_and_management_data['is_the_participant_or_others']['answer_1'] ?? '' }}
Is there evidence that the Participant at the premises may be under the influence of alcohol or drugs? {{ $assessment_and_management_data['is_there_evidence_that_the_participant']['answer_1'] ?? '' }}
Does the Participant have any pets? If yes, will they be securely locked away during the visit? {{ $assessment_and_management_data['does_the_participant_have_any_pets']['answer_1'] ?? '' }}
Does anyone smoke at home? {{ $assessment_and_management_data['does_anyone_smoke']['answer_1'] ?? '' }}
Is there a risk of the Participant or others at the premises using a weapon? {{ $assessment_and_management_data['is_there_a_risk_of_the_participant']['answer_1'] ?? '' }}
Will you be visiting at night or outside of normal working hours? {{ $assessment_and_management_data['will_you_be_visiting_at_night']['answer_1'] ?? '' }}
Has relevant medical history been communicated, inc. potential risk situations? {{ $assessment_and_management_data['has_relevant_medical']['answer_1'] ?? '' }}
Is the home in a high-crime area or an isolated location? {{ $assessment_and_management_data['is_the_home_in_a_high_crime']['answer_1'] ?? '' }}
Does the client/Participant have a blood-borne disease (e.g. HIV/AIDS or Hepatitis B/C)? {{ $assessment_and_management_data['does_the_client_participant_have_a_blood_borne_disease']['answer_1'] ?? '' }}
Does the client/Participant have an airborne disease (e.g. flu, tuberculosis, measles, chicken pox or influenza)? {{ $assessment_and_management_data['does_the_client_participant_have_an_airborne_disease']['answer_1'] ?? '' }}
Does the client/Participant have an infectious disease that can be spread by contact (e.g. herpes, MRSA, scabies, rubella, mumps or ringworm)? {{ $assessment_and_management_data['does_the_client_participant_have_an_infectious_disease']['answer_1'] ?? '' }}
Does the participant require transport support? {{ $assessment_and_management_data['does_the_participant_require_transport']['answer_1'] ?? '' }}
Hazard Identification

(Summary of Risks)

Risk Evaluation

(Current Risk)

Risk Control

(Controls implemented for those Risks)

Staff instructions {{ $assessment_and_management_data['staff_instructions']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['staff_instructions']['answer_2'] ?? '') !!}
Property access suitability {{ $assessment_and_management_data['property_access_suitability']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['property_access_suitability']['answer_2'] ?? '') !!}
Hazards in the home
  - Fire Hazards



  - Poisoning



  - Allergies




  - Falls Hazards 		{{ $assessment_and_management_data['hazards_in_the_home']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['hazards_in_the_home']['answer_2'] ?? '') !!}
Are additional persons expected to be present at the time of the visit? {{ $assessment_and_management_data['are_additional_persons_expected']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['are_additional_persons_expected']['answer_2'] ?? '') !!}
Is the Participant or others known to be potentially aggressive, violent, or disturbed? {{ $assessment_and_management_data['is_the_participant_or_others_known_to_be_potentially_aggressive']['answer_1'] ?? '' }} {!! nl2br( $assessment_and_management_data['is_the_participant_or_others_known_to_be_potentially_aggressive']['answer_2'] ?? '', ) !!}
Is there evidence that the Participant at the premises may be under the influence of alcohol or drugs? {{ $assessment_and_management_data['is_there_evidence_that_the_participant_at_the_premises']['answer_1'] ?? '' }} {!! nl2br( $assessment_and_management_data['is_there_evidence_that_the_participant_at_the_premises']['answer_2'] ?? '', ) !!}
Does the Participant have any pets? If yes, will they be securely locked away during the visit? {{ $assessment_and_management_data['does_the_participant_have_any_pets_if_yes_will_they']['answer_1'] ?? '' }} {!! nl2br( $assessment_and_management_data['does_the_participant_have_any_pets_if_yes_will_they']['answer_2'] ?? '', ) !!}
Does anyone smoke at home? {{ $assessment_and_management_data['does_anyone_smoke_at_home']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['does_anyone_smoke_at_home']['answer_2'] ?? '') !!}
Does anyone smoke at home? {{ $assessment_and_management_data['does_anyone_smoke_at_home']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['does_anyone_smoke_at_home']['answer_2'] ?? '') !!}
Is there a risk of the Participant or others at the premises using a weapon? {{ $assessment_and_management_data['is_there_a_risk_of_the_participant_or_others']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['is_there_a_risk_of_the_participant_or_others']['answer_2'] ?? '') !!}
Will you be visiting at night or outside of normal working hours? {{ $assessment_and_management_data['will_you_be_visiting_at_night_or_outside']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['will_you_be_visiting_at_night_or_outside']['answer_2'] ?? '') !!}
Has relevant medical history been communicated, inc. potential risk situations? {{ $assessment_and_management_data['has_relevant_medical_history']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['has_relevant_medical_history']['answer_2'] ?? '') !!}
Safe transportation {{ $assessment_and_management_data['safe_transportation']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['safe_transportation']['answer_2'] ?? '') !!}
COVID-19 protocols for safe home visiting {{ $assessment_and_management_data['covid_19_protocols']['answer_1'] ?? '' }} Assessment of risk for home visiting

Where appropriate, call ahead to undertake a risk assessment, including identifying if participant/ participant’s family is/are a confirmed, probable, or suspected case of COVID-19. If unsure, ask screening questions:

  • Have you had a positive COVID-19 test result?
  • Are you in close contact with a confirmed case of COVID-19?
  • Do you have a fever or respiratory symptoms, such as a cough, sore throat, or shortness of breath?


If the answer is ‘yes’ to having respiratory symptoms AND to any of the other questions:

  • Advise Participant to contact a GP or the National Coronavirus Hotline (1800 020 080) and seek testing.
  • It is recommended to postpone the home visit or deliver your service electronically (prompts vis phone or dropping essential items at the home).
  • If the face-to-face visit is deemed critical and unavoidable, a short home visit (less than 15 minutes) can be completed by an employee equipped with full personal protective equipment (PPE) — N95 mask (or an authorised SA Health alternative), safety glasses and gloves.


If the answer is ‘no’ to all the above, you can undertake a home visit. The use of a surgical mask is still required for all home visits if social distancing is not possible unless full PPE is required.

During home visits:

  • Minimise physical contact.
  • Maintain a minimum distance of 1.5 metres and ensure a density of no more than 1 person per 2 square metres where possible.
  • Practice universal precautions and infection control procedures; observe general advice on physical distancing and hygiene.
  • Offer the clients a surgical mask to use.




Reference: https://dhs.sa.gov.au/services/cfss/resources/practice-guides/practice-guide-safe-home-visiting

Blood-borne diseases {{ $assessment_and_management_data['blood_borne_disease_2']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['blood_borne_disease_2']['answer_2'] ?? '') !!}
Airborne diseases {{ $assessment_and_management_data['airborne_diseases']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['airborne_diseases']['answer_2'] ?? '') !!}
Contact diseases {{ $assessment_and_management_data['contact_diseases']['answer_1'] ?? '' }} {!! nl2br($assessment_and_management_data['contact_diseases']['answer_2'] ?? '') !!}
@include('backend/hr_module/assessment_and_management/static_text', ['data' => 'pdf_content'])
Home Visit Approved? {{ $assessment_and_management_data['home_visit_approved']['answer_1'] ?? '' }}
Assessor {{ $assessment_and_management_data['assessor']['answer_1'] ?? '' }}
Signature {{ $assessment_and_management_data['signature']['answer_1'] ?? '' }}
Date {{ $assessment_and_management_data['date']['answer_1'] ?? '' }}
Next review date {{ $assessment_and_management_data['next_review_date']['answer_1'] ?? '' }}