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Supplier Registration
Supplier Registration
Please select the most appropriate option for your business
Sole trader - Employs Staff
Sole trader - Only Worker
Partnership
Limited company (Pty Ltd)
Indigenous Organisation
Other
DETAILS ABOUT YOUR ORGANISATION
Entity name*
Entity ABN*
Company Trust Name (if operate as a Trust)
Trust ACN
Do you have OR are you in a position to restructure your business to use another ABN/ACN that is associated with a company, partnership, trust instead of a sole trader ABN?
Yes
No
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
ARE YOUR CONTACT DETAILS DIFFERENT FOR A “SERVICE REQUEST”
Main contact name
Main contact telephone
Main contact email
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:
Is this service provided
Is this service provided
in the home
in a clinic
both
Are you available to start providing services immediately?*
Yes
No
How many of your staff will be providing a service to our clients?
How many of your staff will be providing a service to our clients?
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 $10,000,000 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 or have a NDIS Worker Screening Clearance (issued less than 5 years)
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)
My organisation has taken reasonable steps (including reasonable enquiries) to investigate its labour practices and supply chain, and those of its subcontractors (where relevant), in order to reasonably ensure there is no modern slavery (as defined in the Modern Slavery Act 2018 (Cth)) in its structure, operations or supply chain or those of its subcontractors.
All contractor personnel receive the Australian government approved COVID-19 vaccine (or a valid medical exemption) and continue to satisfy and promptly comply with any vaccination mandate or requirements stipulated by any government authority or body with respect to COVID-19
My organisation has accreditation in national healthcare / aged care / NDIS standards and/or ISO.
Are you able to provide COVID-19 vaccination status for all of your staff?
Yes
No
UPLOAD DOCUMENTATION (most appropriate for your business)
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
NDIS Worker Screening Clearance
Please select a file
Delete file
Price schedule
Please select a file
Delete file
Price schedule (if not attached)
Accreditation and / or Quality Certificate
Please select a file
Delete file
Other
Please select a file
Delete file
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