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Submission received

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This form has been submitted for consideration for the above Application process. Based on system generated information it appears that this Application has been submitted on time. Please note that the submission of this Application does not equate to automatic acceptance of the Application. The Application acceptance notification and information will be provided separately via email to the main email contact provided on this Application. Contact via Phone on or via email for any questions regarding this Application.
This form has been submitted for consideration for the above Application process. Based on system generated information it appears that this Application has not been submitted on time. The Application is therefore unlikely to be accepted. Note that the submission of this Application does not equate to automatic acceptance of the Application. The Application acceptance notification and information will be provided separately via email to the main email contact provided on this Application. Contact via Phone on or via email for any questions regarding this Application.
Your form has been received by the NDIS Quality and Safeguards Commission. We will review your request to register for Worker Screening. Until then, you can visit our website for more information on Worker Screening.
Business legal name
NDIS Participant name
Reference number
Submission date

Next steps

1.We will review your request to register for Worker Screening and send you an email with the outcome. 2.If your request is approved, the primary contact will receive an email with instructions on how to login to the NDIS Worker Screening Database.
3.We will review your request to register for Worker Screening. This may take up to XX business days. 4.When your request is approved, you and your key contacts will receive an email with instructions on how to login to the National Worker Screening Database.
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Form Saved

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Your form has been saved for submission later.
Your reference number:

Updating your form

If you do not update or submit this form within 60 days, it will be deleted. Only one person should update this form at a time. If more than one person tries to complete this form at the same time, the information entered may be lost. Please ensure each person has completed their updates, saved their changes and closed the form prior to another person accessing the same form.
Your Submission Reference is:
Please send yourself a link to this saved form by entering your email address below. This email will detail your Submission Reference, the date and time this application process will close, and a link to access your saved form.If you have any questions relating to this Application phone or email .

Send yourself a reminder email

Enter your email address and we'll send you instructions on how to return to your form.
Please enter your email and we will send you instructions on how to resume your saved form.

Check your email

We've sent instructions to your email address () on how to return to the application when you are ready. If you didn't receive it or would like a reminder send to a different email address, just click the link below and follow the instructions.
Register for Worker Screening

Form Information

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Completing this form

For each person that requires access to the NDIS Worker Screening Database, we recommend you enter: •their current legal name, as displayed on their identity documents; and •a unique email address. This email address should not be shared by two people that both need access to the Database. Each person's legal name will be checked at a later date against the information listed on their PRODA account. If you or a contact listed only has a single name, please enter it in the 'Last name' field and leave the 'First name' field blank.
Although registering for PRODA is essential to gain access to the NDIS Worker Screening Database, it should be noted that this registration by itself does not make you an NDIS registered provider.

Saving and submitting your form

Your reference number:
Each form has a unique reference number. This is located at the top right of every page. Please enter your email below and we will send you a link to your saved form.
You can return to this form by using the link sent to your email or selecting 'Resume a saved form' and entering your reference number. If you do not update or submit this form within 60 days, it will be deleted. Once you have submitted the form, you will receive an on-screen confirmation that the application has been lodged. This will also be sent to the email address you specify with a copy of your submission.If your request to 'Register for Worker Screening' is approved, then the primary contact for your account will need to register for a PROvider Digital Access (PRODA) account.
Registering for PRODA is essential to gain access to the NDIS Worker Screening Database. However, it should be noted that registering for a PRODA account does not make you a registered NDIS provider.

Sharing this Form

Only one person should update this form at a time. If more than one person tries to complete this form at the same time, the information entered may be lost.

National Relay Service (NRS)

The National Relay Service is a free Australia-wide phone service for people who are deaf or have a hearing or speech impairment. You can contact the NDIS Quality and Safeguards Commission via:•the National Relay Service and ask for 1800 035 544•TTY/voice, call 133 677•Speak & Listen, call 1300 555 727•SMS relay, message 0423 677 767You can find more information on the National Relay Service website.

Use of information and the system

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Privacy collection statement

The NDIS Quality and Safeguards Commission (NDIS Commission) is bound by the Australian Privacy Principles (APPs) outlined in Schedule 1 of the Privacy Act 1988 (Cth) (Privacy Act) which regulate how entities may collect, use, disclose and store personal information. The NDIS Commission is also bound by the information management provisions of the National Disability Insurance Scheme Act 2013 (the NDIS Act). These provide that if the NDIS Commission holds information about a person in its records then that information is regarded as “protected Commission information” under the NDIS Act. An example of protected Commission information is information about a worker on the NDIS Worker Screening Database. Unauthorised use and disclosure of protected Commission information by any person is a criminal offence under the NDIS Act.Collection of your personal informationAs a self-managed participant or an unregistered provider, you need the approval of the NDIS Commission to access the NDIS Worker Screening Database. By completing this form, you are applying to be a registered user of the NDIS Worker Screening Database which will enable you to access it. If your application is approved, you will be issued with an ID number to be used for the purposes of the NDIS Worker Screening Database.The NDIS Commission will collect information from you on this form including personal information such as names, date of birth, email addresses and phone numbers.The NDIS Commission is collecting your personal information for the purposes of:•assessing whether you are eligible to access the NDIS Worker Screening Database;•communicating with you about:
â—¦the applicationâ—¦the NDIS Worker Screening Databaseâ—¦matters which are of interest or relevance to employers of NDIS workers such as updates or available education, training or resources
•exercising the NDIS Commissioner’s functions in relation to the NDIS Worker Screening Database
•exercising the NDIS Commissioner‘s other functions under the NDIS Act including communicating with you in the exercise of those functions If you do not provide us with the personal information sought in this form, the NDIS Commission may not be able to assess your application to access the NDIS Worker Screening Database.If your application to access the NDIS Worker Screening Database is approved, the NDIS Commission will provide some of the personal information to the Worker Screening Units in the Australian states and territories participating in the NDIS Worker Screening Check. The information which will be provided is:•If you are an unregistered provider: the name of your entity as set out in your application form which may be your personal name if you are a sole trader, your business details and your ID number issued to you by the NDIS Commission; and•If you are a self-managed participant: your last name and your ID number issued to you by the NDIS Commission.
The above information will be disclosed to assist the Worker Screening Units to update their records of NDIS employers. This will enable potential workers you have identified to search for your details on the State or Territory worker screening records and link to you as their employer. Potential workers will need to do this as part of the process of undergoing a NDIS Worker Screening Check. The above information may be available to any person in the course of their search for NDIS employers in the State or Territory worker screening records. For example, the information may be shown in a drop-down list of NDIS employers or included in the search results when a person searches for an NDIS employer by name.The NDIS Commission may also use and disclose some or all of the information collected from you for the purposes of the NDIS Act including disclosing it to the National Disability Insurance Agency (the NDIA) for the purposes of research and policy development in relation to the National Disability Insurance Scheme. The NDIS Commission may also use or disclose some or all of the information collected from you for the purposes of performing the functions of the NDIS Commissioner under the NDIS Act which do not relate to the NDIS Worker Screening Database such as the complaints function or the reportable incidents function.Personal information obtained will only be used and disclosed for the purposes and in the circumstances outlined above and will not be used or disclosed without your consent for any other purpose or in other circumstances, except as authorised under the Privacy Act or where authorised or required by law, including by the NDIS Act. Personal Information obtained will be stored and held in accordance with the NDIS Commission’s obligations under the Privacy Act 1988 (Cth) and the Archives Act 1983 (Cth). The NDIS Commission’s Privacy Policy contains information about how you may access and seek correction of your personal information and how you may complain about a breach of the APPs.

User access responsibilities

If your application to be a registered user is approved, you and the key contacts identified (if relevant) will be granted access to the NDIS Worker Screening Database where you will be able to view limited information. As a registered user of the NDIS Worker Screening Database, you (and your key contacts) have the user access responsibilities set out below.The NDIS Worker Screening Database is an Australian Government computer system managed by the NDIS Commission.These are the conditions of your access to the NDIS Worker Screening Database:If you are an NDIS participant who manages their own NDIS Plan (self-managed participant):
•You must only access, use and disclose information in the NDIS Worker Screening Database to the extent that is necessary for you to administer your self-managed NDIS Plan, including in relation to NDIS Worker Screening checks for any workers you wish to engage ; orIf you are an unregistered Provider:
•You must only access, use and disclose information in the NDIS Worker Screening Database to the extent that is necessary for you to satisfy yourself of a NDIS Worker Screening check, which you have determined is necessary to be undertaken.
Information contained on the NDIS Worker Screening Database is subject to the Privacy Act 1988. Any unauthorised use or disclosure of information contained on this system may be a breach of the Privacy Act 1988. The information may also be “protected Commission information” under the National Disability Insurance Scheme Act 2013. Protected Commission information includes information that is held by the Commission about a person.Any protected Commission information on the NDIS Worker Screening Database may be used or disclosed as authorised by the National Disability Insurance Scheme Act 2013. However, your use and disclosure of the protected Commission information on the NDIS Worker Screening Database is limited by the access conditions listed above. Unauthorised use and disclosure of protected Commission information is a criminal offence under the National Disability Insurance Scheme Act 2013. It is also a criminal offence for unauthorised persons or devices to connect to the NDIS Commission’s computer systems, including the NDIS Worker Screening Database. Usage of those systems is monitored. Evidence of suspected misuse may be used in a court of law. You should also note that giving false or misleading information to the Commonwealth is a serious offence under section 137.1 of the Criminal Code Act 1995 (Cth).The NDIS Commission may revoke the NDIS Worker Screening Database access rights for anyone who fails to comply with the access conditions or who contravenes the law as referred to above.By submitting this form, you are representing that if you become a registered user of the NDIS Commission computer systems referred to above, you will abide by these user access conditions and you are acknowledging the legal requirements and penalties for contravention as set out above.

Who are you? *

My NDIS Plan

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How do you manage your NDIS plan? (select all that apply) *
Contact your NDIS Provider As part of the NDIS Code of Conduct, your registered NDIS Provider is required to ensure your workers have a valid NDIS Worker Screening Check. Please contact your registered NDIS provider to verify your workers have a Worker Screening Clearance. Visit the NDIS Commission website for more information.

NDIS Participant details

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Fields marked with * are required
Please provide the NDIS Participant's details.
Does the NDIS Participant require access to the NDIS Worker Screening Database? * For the purposes of Worker Screening, the participant will be responsible for managing their workers on the Database.

Contact details

Please provide a unique email address for the NDIS Participant. Each person that requires access to the Database will need a unique email address. Note: The participant will receive email notifications related to Worker Screening. This includes updates about status changes for linked workers and when a worker's check is due to expire.
The participant will receive email notifications related to Worker Screening. This includes updates about status changes for linked workers and when a worker's check is due to expire.

Never Visible_Service areas

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Fields marked with * are required
Which state/territory does your organisation operate in? (select all that apply) *
Please comply with existing worker screening arrangements The NDIS Worker Screening Check will be available in Western Australia in 2020. Until then, providers will need to comply with their state and territory worker screening arrangements. Visit the NDIS Commission website for more information.

Business details

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Fields marked with * are required

Australian Business Number

Please provide a valid Australian Business Number (ABN). We will search the Australian Business Register (ABR) to validate your ABN.
Enter the ABN Branch Number relevant to the Applicant’s ABN, if applicable. This is limited to 3 digits.
If you have Trading/Business Names registered, you can select the relevant Business Name. If you have not registered your Business Name, you can either select "Same as Legal Entity" or "Other" in the "trading name/business name" field. If "Other" is selected, you will be asked to provide the Applicant's trading/business name in another field that will become available.
Enter your ACN into the Australian Company Number (ACN) field and click the Validate ACN button to retrieve your registration details.

Business contact details

Business address

Address Validated
Address NOT Validated

key contacts

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Fields marked with * are required
Does the NDIS Participant require access to the NDIS Worker Screening Database? *

For the purposes of Worker Screening, the participant will be considered the Primary Contact and will be responsible for managing their workers on the Database.
Does the NDIS Participant require access to the NDIS Worker Screening Database?
List one or more key contacts for the NDIS Participant *
List one or more key contacts for the NDIS Participant
List one or more key contacts for the organisation. *
Contact
Successfully Verified
My contact can: Select if you would like this contact to receive email notifications related to Worker Screening. This includes updates about status changes for linked workers and when a worker's check is due to expire.

Confirm details

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Fields marked with * are required
For each person, please double check that you have listed:•their current legal name, as shown on their identity documents; and •the correct email address.
If they only have a single name, please enter it in the 'Last name' field and leave the 'First name' field blank. Their legal name will be checked at a later date against the information listed on their PRODA account.
Registering for PRODA is essential to gain access to the NDIS Worker Screening Database. However, it should be noted that registering for a PRODA account does not make you a registered NDIS provider.
Each person's legal name will be checked at a later date against the information listed on their PRODA account.
First name
Middle name
Last name *
Email address *

The Primary contact

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Fields marked with * are required
Nominate one person to become the Primary Contact.Subject to the NDIS Commission's approval, the Primary Contact will be able to access the NDIS Worker Screening Database on behalf of the organisation They will be:•considered the primary point of contact for the organisation;•able to verify whether a worker is currently working, or intends to work for the organisation; and (Verifying a worker progresses their application for screening)•able to manage the organisation’s workers.
They will also receive an additional role, the Access Delegate. In this role, this person will be responsible for: •the organisation's account; and•managing user access to the Database on behalf of the organisation. This includes adding and removing someone's access to the Database.
Nominate one person to become the Primary Contact. Subject to the NDIS Commission's approval, the Primary Contact will be able to access the NDIS Worker Screening Database on behalf of the participant. They will be:•considered the primary point of contact;• able to verify whether a worker is currently working, or intends to work for the participant; and (Verifying a worker progresses their application for screening)•able to manage the participant's workers.
They will also receive an additional role, the Access Delegate. In this role, this person will be responsible for: • the participant's account; and• managing user access to the Database on behalf of the participant. This includes adding and removing someone's access to the Database.
You have identified that the NDIS Participant requires access to the Database. As such, they have been nominated to be the Primary Contact. If you select another person as the Primary Contact, then the participant will not receive access to the Database upon approval.
Select one person from the list below: *

Participation in the NDIS market

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Fields marked with * are required
Do you provide supports or services to the following? (select all that apply)
(Limit: approx 300 words, 2,000 characters)

Workers

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Fields marked with * are required
Please Identify any workers that have applied for an NDIS Worker Screening CheckBy linking to a worker: •You indicate that this person does (or intends to) provide NDIS support services for you; and•You or your nominated contacts will receive any updates on changes to their status; and•You will be able to see the worker's current status and eligibility to provide NDIS services.Please input the worker's last name and either their Application Id or Worker Screening Id, then select Check.

Summary & declaration

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Fields marked with * are required

Business details

ABN
Legal name
ACN
Business name
Business email address
Website
Business phone number
Business address

NDIS Participant details

Name
NDIS number
Date of birth
Email address
Phone number
Is the NDIS Participant the primary contact?

key contacts

Name
Gender
Worker Screening Id
Email address
Phone number
My contact can:

The Primary Contact

Name
Email address

Participation in the NDIS market

I provide supports or services to:
Please provide a brief summary and list of the supports or services your organisation provides in the NDIS market

Workers

Worker's last name
Worker Screening Id / Application Id

Statutory declaration

I declare that: •I am an NDIS Participant or am authorised to act on behalf of the NDIS Participant identified above•I understand that the information on this form is being collected by the NDIS Quality and Safeguards Commission (NDIS Commission) for the purposes set out in the Privacy Collection Statement•I have read and understood the Privacy Collection Statement and consent to the NDIS Commission collecting, using and disclosing my personal information for the purposes and in the circumstances set out in that Statement, including for the purposes of the NDIS Commissioner undertaking statutory functions under the National Disability Insurance Scheme Act 2013 (Cth). •I have ensured that any other person whose personal information is included in this form has read and understood the Privacy Collection Statement and they have also consented to their personal information being collected, used and disclosed by the NDIS Commission for the purposes and in the circumstances set out in that Statement, including for the purposes of the NDIS Commissioner undertaking statutory functions under the National Disability Insurance Scheme Act 2013 (Cth). •I have read, understood and agree to abide by the user access responsibilities•To the best of my knowledge, the information provided in this application is true, correct and accurate.
I declare that:•I am authorised by the business identified above to submit this form •I am, or will be, involved in the delivery of NDIS supports and services to NDIS participants in accordance with their NDIS Plan•I understand that the information on this form is being collected by the NDIS Quality and Safeguards Commission (NDIS Commission) for the purposes set out in the Privacy Collection Statement.•I have read and understood the Privacy Collection Statement and consent to the NDIS Commission collecting, using and disclosing my personal information for the purposes and in the circumstances set out in that Statement, including for the purposes of the NDIS Commissioner undertaking statutory functions under the National Disability Insurance Scheme Act 2013 (Cth). •I have ensured that any other person whose personal information is included in this form has read and understood the Privacy Collection Statement and they have also consented to their personal information being collected, used and disclosed by the NDIS Commission for the purposes and in the circumstances set out in that Statement, including for the purposes of the NDIS Commissioner undertaking statutory functions under the National Disability Insurance Scheme Act 2013 (Cth). •I have read, understood and agree to abide by the user access responsibilities •I will ensure that the key contacts of my business have read, understood and agree to abide by the user access responsibilities.•To the best of my knowledge, the information provided in this application is true, correct and accurate.

Selection Criteria

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Header Text

Question Detail
(Limit: approx characters)

Attachments

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Header Text

Question Detail
List of attachments.
File:

Header Text

Question Detail
List of attachments.
File:

Header Text

Question Detail
List of attachments.
File:

Submission Parameters

Application

Legal Entity

Service Provider

Payee

NDIS Participant

Provider

Department Use Only

Funding Round Details - the following information is pre-populated from the FOFMS funding round:
CGH STD APP v1.0