Buddy Shift Checklist Form

This form is to be completed by the Lifestyle Assistant being trained during the time allocated by the Rostering Team.

Before you start, please ensure you have access to the Service User’s About Me link as you will require this to complete the form below.

Should there be any issues, please contact the RLO office.

Date of Buddy Shift *

Service User (SU) *

Service User Name

Lifestyle Assistant (LA) receiving training: *

Name of Lifestyle Assistant (LA) receiving training

LA or RLO Representative providing training: *

What is the SU’s disability/s and/or diagnosis/s, including any specific medical issues? e.g., diabetes, epilepsy, etc *

Does the SU have any allergies? Please provide details of the allergen, symptoms and, assistance needed. *

Does the SU have any dietary requirements or intolerances? Please provide details. *

Is there any situation throughout the day in the course of your duties where you are required to physically assist the SU? If so, please provide details. *

What are the SU’s identified risks and what should you do to best assist them to manage these risks? *

What does it look like if the SU appears to be anxious, stressed or mentally unwell and how should you assist them in these circumstances? *

Please list the name and numbers of at least 2 people who should be contacted in the event of an emergency: *

Please list any formal/informal decision makers if applicable: *

Are there any specific considerations/directions for what happens in a medical emergency/natural disaster. Please state all considerations and directions: *

What is the process if the SU is not answering the door? Please state if there is a spare key and its location, and/or a lock box and its location and code. *

Please describe if the SU has any support requirements regarding their gender, sexuality, culture, diversity, and identity. Please also state how the SU identifies and what pronouns they use. *

What form/s of communication does the SU use? (Please list all) *

Are there any other methods for recording your shift notes other than Akuety? *

Do LAs have any role in assisting the SU with their money or finances? *

Does the SU have any support plans in place? If so, please state which ones and where you can access them. Please note: A minimum of one face-to-face buddy shift will need to take place if a SU has any support plans. *

Medication assistance requirements are directed in conjunction with the SU, their families, NDIS and RLO’s policies and procedures.

Does the SU need assistance with their medication? If so, please state what assistance is required, including medication storage location, as well as medication form location if applicable. *

Regardless of how we assist a SU with medication all medication incidents must be reported immediately via an incident form in Akuety.

Any serious errors or incidents associated with a SU taking medication must be reported to 000, followed by the Representative/Nominee of the SU and then to Real Living Options Association Inc. as soon as is practically possible. If the situation is not considered an emergency, advice relating to medication errors and incidents should always be sought in the following order:

The Pharmacist or Health Care professional (General Practitioner) of the SU. If the Pharmacist or General Medical Practitioner of the SU are unavailable, then contact any of the following:

- The Adverse Medicines Event Line on 1300 134 237 (Mon-Fri 9am-5pm) regarding suspected side effects from a medication.

- The Medication Helpline (Mon-Fri 9am-5pm) 1300 888 763

- 13 Health on 13 432584 (24 hours) regarding health concerns that are not an emergency but considered serious.

- The QLD Poisons Information Centre on 13 11 26 (24 hours) regarding drug overdoses or suspected overdoses. Situations may include if a SU has taken too much of their own medication, taken the wrong medication or taken a medication via the wrong route.

An incident would include but is not limited to:

Medication omitted (not taken)

Incorrect dose taken.

Medication taken at the wrong time.

Medication incorrectly packaged or supplied.

Medication refused by the SU.

Medication not available.

Suspected abuse of medication.

Medication where directions have not been followed accurately by the SU.

Any situation where staff have a concern relating to medication.

Do you understand what this means in practice? *

• NO
• YES

Please provide details as to what you don't understand: *

Does the SU require any personal care assistance? If so, please describe what type of assistance is required. *

When assisting with personal care, it is important you maintain the highest level of dignity for the person being supported as well as observing ‘Workplace Health and Safety Requirements’. Do you understand what this means in practice? *

• NO
• YES

Please provide details of why you answered NO to this question: *

Do you feel competent with all aspects of the personal care that you may provide? *

• NO
• YES

the Date who

Please provide details of why you answered NO to this question : *

Work Health & Safety (WHS): should you identify any potential hazards in the SU’s household, you must complete a WHS Incident form through your shift in Akuety so hazards can be identified and dealt with in real time by the RLO office. Do you understand what this means in practice? *

• NO
• YES

Please provide details of why you answered NO to this question: *

Please state and describe (if applicable) if there is any situation throughout the course of your duties where you must wear Personal Protective Equipment (PPE)? Please also state if the SU has any PPE available at their home. Please note: the RLO office can supply PPE if required. *

Does the SU require assistance during their support for any regular appointments? Please describe what appointments including location, day/frequency, etc. *

Depot/Clozapine/Bloods/Medical/allied health appointments: when assisting a participant with attending any medical or allied health appointments, even if just transporting them, LAs must complete and submit a GP or Allied Health Care Plan form through the RLO website. Add any important information to these forms, such as changes in medication, especially if RLO assists them with this, and if there is a future appointment in which support from RLO is required. Please notify the office asap via call or text if the follow up appointment is with short notice so to allow the office time to organise supports in a timely manner. Do you understand what this means in practice? *

• NO
• YES

Please provide details of why you answered NO to this question: *

Please provide details of what types of activities you will be supporting this SU with, e.g., cooking, cleaning, shopping, access community, etc. *

Are there any specific directions for how to best support them? e,g., needs help cutting vegetables, SU can remove bedding but requires help making it, SU is responsible for own children – not to be left alone with LA, etc. *

What are some of the SU’s likes, interests or hobbies? *

What are some of the SU’s dislikes or triggers? *

Is there any other important information that has not been captured by the above questions? e.g., do not share number as the SU will call inappropriately, all discussions of support to come through office, etc. *

Please list the SUs Current NDIS goals and how you will support the SU to achieve them: *

Are you aware of what is required if you are sick or unable to work? *

• NO
• YES

Please provide details of what you should do *

Some Service Users you support will require multiple buddy shifts before you can support them independently. Please answer the following questions:

I feel I require more training before I start supporting this SU *

• NO
• YES

Details of training required

• I would like another Buddy Shift
• I have another Buddy Shift already scheduled
• I feel I need other training

Date of Buddy Shift already scheduled

Please provide details of what training you feel you require? *

I feel I require more information before I start supporting this SU? *

• NO
• YES

Please provide details of what information you feel you require? *

I feel I am a suitable match with this SU? *

• NO
• YES

Please provide details of why you think you are a suitable match with this SU *

Please provide details of why you think you are not a suitable match with this SU *

I am aware that I can ask the office for further training at any time *

• NO
• YES

Please provide details of who you would ask for further training if you felt you needed it? *

I am confident I have been given sufficient information, training, and the opportunity to learn about their support needs and I am competent to begin safely supporting this SU. *

• YES
• NO

I am ready to begin supporting this Service User

I am NOT ready to begin supporting this Service User

By signing below you are confirming that you believe you have been given appropriate training and support and the opportunity to learn about their needs to begin working with the Service User you have completed this Buddy Shift for?

Signature *

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Submit Buddy Shift Checklist