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Supplier Registration
Supplier Registration
Please select the most appropriate option for your business
Sole trader
Partnership
Limited company (Pty Ltd)
Other
DETAILS ABOUT YOUR ORGANISATION
Legal entity name*
ABN*
Trading as name
YOUR ADDRESS DETAILS
Street address*
Select your state*
Select your state*
QLD
SA
TAS
NT
ACT
VIC
NSW
WA
Suburb*
Postcode*
POSTAL ADDRESS
Is your postal address different to your street address?
Yes
No
YOUR CONTACT DETAILS
Main contact name*
Main contact telephone*
Main contact email*
Main contact fax
WHAT SERVICES ARE YOU ABLE TO PROVIDE?
Please select all that apply
Personal care services
Social support services
Respite care services
Therapy services
Medication requirement
Nursing services
Meal delivery services
Transport services
Flexible care tasks (assist consumers within home environment)
Domestic assistance
Intensive cleaning/spring cleaning
Home modification services
Home maintenance and handyman services
Gardening services
Roof and gutter cleaning services
Pest control services
Allied health services
Podiatry
Physiotherapy
Occupational therapy
Speech pathology
Dietitian or nutrition
If you provide services that are not listed above, please specify them here:
Are you available to start providing services immediately?*
Yes
No
WHICH REGION BEST REPRESENTS THE AREA/S YOU SERVICE?
Please list the city/area/suburbs/towns in which you are prepared to work
DECLARATION
Please only select what is applicable to your services
My organisation has the workers' compensation insurance as required under relevant state legislation covering all contractor personnel
My organisation has the public liability insurance for at least the sum of $20,000,000 for any one occurrence
My organisation has the professional indemnity insurance for at least the sum of $20,000,000 for any one occurrence
My organisation has the medical indemnity for at least the sum of $20,000,000 for any one occurrence (where relevant)
My organisation has the cyber security insurance for at least the sum of $5,000,000 for any one occurrence
My organisation is an approved provider under the Aged Care Act 1997 (cth)
My organisation has a system in place to manage and control HSE hazards and risks
My organisation has an incident reporting process that ensures incidents are reported and responded to promptly
My organisation complies with all applicable laws, regulation and standards governing aged care and health care (where relevant)
All contractor personnel have current National Police Check (issued less than 3 years) and relevant state screening clearances (as required) to provide the services
My organisation has policies and procedures to demonstrate management and monitoring of the national police checks for all personnel
All contractor personnel have appropriate licences, qualifications, experience and competencies to provide the services to consumers
Contractor personnel have the necessary professional/regulatory registrations/licences required to provide relevant services
All contractor personnel transporting consumers have current valid motor vehicle drivers’ licences
All contractor personnel are being paid at or above minimal wage or award rates (as applicable)
UPLOAD DOCUMENTATION
Public liability insurance certificate
Please select a file
Delete file
HSE policies and/or HSE management plan
Please select a file
Delete file
Professional indemnity insurance certificate
Please select a file
Delete file
Workers’ compensation certificate
Please select a file
Delete file
AHPRA registration/trade licences
Please select a file
Delete file
Police clearance certificates or company policy
Please select a file
Delete file
Price schedule
Please select a file
Delete file
Price schedule (if not attached)
Other
Please select a file
Delete file
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