All Errors
You must agree to the requirements and conditions before proceeding
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Organisation you wish to be registered with
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Services you wish to be registered for (please select at least one)
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ABN/ACN
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Registered Business / Company Name
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Trading Name (if applicable)
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TAC
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WorkSafe
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Registered Business Address
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Postal Address (if different from above)
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Business Telephone
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Business Email
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Website Address
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Services Areas (e.g. Local Government Area)
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Type of registration:
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Name
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Position
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Business Telephone
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Mobile
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Email
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Are there any events, matters or circumstances that have arisen within the last financial year that may significantly affect the operations of your organisation?
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Please provide details
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Are there any mergers or acquisitions imminent or have taken place within the past 12 months?
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Please provide details
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Are there any legal proceedings (actual or threatened) against your organisation, associated entities or directors within the past five years?
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Please provide details
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Are there any actual or potential insolvency or bankruptcy actions against your organisation, associated entities or directors within the past five years?
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Please provide details
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Are there any actual or potential de-registration actions against the Provider, associated entities or directors within the past five years?
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Please provide details
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Are there any breaches or defaults under any agreement, contract, order or award that would likely adversely affect the capacity of your organisation to provide the services being registered for?
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Please provide details
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Are there any other factors that could adversely impact of the financial viability of your organisation and its ability to provide the services being registered for?
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Please provide details
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Are you registered for GST?
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Number of years your organisation has been providing Disability Services
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If providing disability services for less than 2 years, please comment upon disability specific experience of the business leadership team
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Length of time registered with NDIA/ DHHS
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Please tell us how many clients you have per funding stream (for eg. 50 DVA, 5 TAC, 20 DHHS, 10 WSV....)
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Does your organisation specialise in any of the following areas?
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Other input
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Please provide evidence of your accreditation as a disability services provider with another relevant organisation to proceed with your application
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Other input
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Please upload current Registration Certificate
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Registration Certificate
Please upload current Letter of Registration
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Letter of Registration
Please upload relevant registration
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Other relevant registration certificate
Does your organisation sub-contract to other agencies?
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Please outline quality / safeguarding management processes (e.g. Use of Service Agreements with specific requirements) to ensure you maintain oversight and responsibility of sub-contracted services:
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Does your organisation employ family members / friends of clients?
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Do you have a policy outlining how you manage potential conflict of interest/safeguard clients? If yes, please upload your policy.
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A policy outlining how registrant manage potential conflict of interest / safeguard clients
Reference 1
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References from independent community and/or health professionals #1
Reference 2
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References from independent community and/or health professionals #2
Please upload your organisation’s Code of Conduct/ Ethics and/or Service Charter.
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Organisation’s Code of Conduct/ Ethics and/or Service Charter
Please upload your Organisational Structure
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Organisational Structure
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Provider demonstrates commitment to the principles of zero tolerance and ensure they promote an environment that is free from abuse, neglect, exploitation and preventable injury.
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Please upload evidence
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Provider demonstrates commitment to the principles of zero tolerance and ensure they promote an environment that is free from abuse, neglect, exploitation and preventable injury.
Provider has policies and procedures in place for supporting Clients/Workers and responding to potential or actual abuse, neglect, exploitation and preventable injury. These policies clearly identify how Clients/Workers will be supported following allegations of abuse.
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Please upload evidence
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Provider has policies and procedures in place for supporting Clients/Workers and responding to potential or actual abuse, neglect, exploitation and preventable injury. These policies clearly identify how Clients/Workers will be supported following allegations of abuse.
Provider demonstrates a commitment to promoting and upholding the rights, dignity, wellbeing and safety of Clients/ Workers and will not tolerate abuse, neglect or exploitation of any kind.
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Please upload evidence
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Provider demonstrates a commitment to promoting and upholding the rights, dignity, wellbeing and safety of Clients/ Workers and will not tolerate abuse, neglect or exploitation of any kind.
Provider has clearly documented processes for supporting employees who report abuse.
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Please upload evidence
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Provider has clearly documented processes for supporting employees who report abuse.
Provider has documented processes regarding the handling of Clients/ Workers’ money, including what safeguards are in place to protect clients from financial abuse and how discrepancies are managed.
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Please upload evidence
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Provider has documented processes regarding the handling of Clients/ Workers’ money, including what safeguards are in place to protect clients from financial abuse and how discrepancies are managed.
Any staff working directly with a Client/ Worker complete induction and/or continuous improvement training that outlines how to identify signs of neglect, abuse and exploitation in addition to the Disability Service Standards which specify responding to and reporting abuse.
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Please upload evidence
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Any staff working directly with a Client/ Worker complete induction and/or continuous improvement training that outlines how to identify signs of neglect, abuse and exploitation in addition to the Disability Service Standards which specify responding to and reporting abuse.
Providers will adhere to the TAC and WorkSafe Serious Incident Reporting Process.
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Any Provider working directly (this includes physical, face-to-face, written, oral or electronic contact) with children must meet the Victorian Child Safe Standards and any staff working directly with a Client/Worker who is under the age of 18 must have a current Working with Children Check (WWCC).
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All staff working directly with a Client/ Worker must have a cleared National Police Check.
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All staff working directly with a Client/ Worker are to be checked against the DHHS Disability Worker Exclusion Scheme (DWES) and are to be not excluded by the register.
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In order to meet the TAC/ WorkSafe Registration Requirements, you will also need to confirm that that your organisation adheres with the following training and induction requirements for all staff working directly with clients/ workers:
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Please upload training calendar
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Training calendar
If applying for Client Independence Support Service (CISS), you have read the CISS Requirements and confirm that all staff working with CISS clients will have a minimum of Certificate IV in Disability, Community Services or equivalent.
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Your organisation has a Conflict of Interest Policy
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Please upload policy
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Conflict of Interest Policy
Your organisation has a Confidentiality and Privacy Policy
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Please upload policy
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Confidentiality and Privacy Policy
Your organisation has a Complaints Policy and information regarding the process is provided to clients
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Please upload policy
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Complaints Policy and information regarding the process is provided to clients
Your organisation has a current Public Liability Insurance Policy (min. $5M)
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Please upload policy
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Public Liability Insurance Policy (min. $5M)
Your organisation has a current Professional Indemnity Insurance Policy (min. $5M)
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Please upload policy
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Professional Indemnity Insurance Policy (min. $5M)
Please upload the signed confidentiality deed poll
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The signed confidentiality deed poll
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Business / Company Name
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Trading Name (if applicable)
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Name of Authorised Representative
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Position
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Date (DD/MM/YYYY)
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