Accessible Participant Feedback Form

An accessible feedback form with faces, simple questions and space for compliments, concerns and ideas, explaining how feedback is used and other ways to raise concerns.

Preview of the first page of Accessible Participant Feedback Form
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Client group
NDIS participants, families and supporters giving feedback to a provider.
Practice setting
Provider feedback and complaints processes.
Format
Templates and planning tools
Details
A4 PDF, printable
Pages
2
Editable version
Word (.docx), for Plus members
Demographics
Children, Teens, Adults
Age groups
All ages
Access
Plus members
Resource code
PP-NDIS-018
Version
1.0

About this resource

Feedback helps services improve, but standard forms can be hard to use. This accessible form uses faces and simple questions about how the person was treated, communication and support, with space for compliments, concerns and ideas. It explains what happens next and other ways to raise concerns.

Purpose

To make it easy and safe for participants to give feedback in a way that suits them.

Who it is for

Primary profession: NDIS providers and support coordinators. Also relevant for disability support workers.

Client or participant group: NDIS participants, families and supporters giving feedback to a provider.

Practice setting: Provider feedback and complaints processes.

Suggested uses

  • Ongoing feedback
  • Service reviews
  • After a change or incident
  • Quality improvement

Instructions for practitioners

  1. Offer the form in different ways: paper, online, by phone or in person.
  2. Make it clear that feedback will not affect services.
  3. Respond within your stated timeframe.
  4. Record and act on feedback according to your complaints management process.

Instructions for clients or participants

  1. Circle a face for each question.
  2. Write or say anything else.
  3. Give it to someone you trust or send it to us.

Accessibility considerations

Faces, plain language and large print. Can be completed with support or verbally.

Scope and limitations

A feedback form template. It does not replace your complaints management system or obligations.

Research basis

Human rights frameworks and research on the dignity of risk support people's right to make their own choices, including choices that involve some risk. Easy Read standards and disability rights frameworks support people's right to accessible information; test Easy Read materials with the people who will use them.

What is included

A 2-page printable A4 PDF, including a practitioner notes page with the research basis (version 1.0).

Originality

Original Practitioner Plus content: wording, activity structure, layout and icons were created for this resource. No third-party worksheets, illustrations or text were reproduced.

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