Start the visit record or review the task-list guide, or contact Smurfettes.
This NDIS cleaning visit record captures what was confirmed, what occurred and what needs follow-up for one indoor household-cleaning visit. Complete it from direct observations and provider records, not guesses. It supports review and invoice checking but is not an attendance ruling, clinical note, funding approval or provider invoice.
Participant or agreed identifier: ____________________________________________________
Service address: _________________________________________________________________
Scheduled date and confirmed arrival window: ________________________________________
Provider and worker name or identifier: ______________________________________________
Person completing this record and role: ______________________________________________
Document dates or versions: _______________________________________________________
Do not attach a full plan or unrelated health record when the bounded service documents are enough.
Rooms or items not to enter, move or touch: _________________________________________
Arrival recorded from: direct observation / provider record / authorised contact / another source: ______
Actual arrival time: __________________ Actual finish time: __________________
Break or interruption relevant to the service record: _________________________________
Person present or access method used: ______________________________________________
If a fact is unknown or disputed, mark it unknown or disputed. Do not invent an exact time to complete the form.
Use Completed, Partly completed, Not completed, Not attempted or Not applicable:
Record observable outcomes rather than a general rating alone.
Change requested during the visit: _________________________________________________
Person requesting it and verified authority: _________________________________________
Provider response: accepted / declined / assessment needed / future quote needed
Task removed or substituted: ______________________________________________________
A person being present at the property does not automatically authorise them to expand the scope.
Factual access note and action: ____________________________________________________
Do not write a reusable code or key location into a broadly shared record.
Product or equipment arrangement used: ____________________________________________
Sensitivity or surface restriction followed: __________________________________________
Substitution requested and who approved it: __________________________________________
Unfamiliar surface or assessment-only condition found: ________________________________
Stop-and-ask decisions should remain visible instead of being rewritten as completed work.
What occurred, where and when: ___________________________________________________
Immediate action taken: ___________________________________________________________
Relevant photo or document reference, if authorised: _________________________________
Person notified and time: __________________________________________________________
Call 000 for immediate danger. A routine record is not an emergency report.
Action, owner and requested date: _________________________________________________
When the invoice arrives, compare the service date, description, quantity, price basis and any additional line with the actual records. Use the invoice checker and keep any correction request with both invoice versions.
A visit record does not establish that every invoiced item is funded or payable. Those questions require the agreement, plan and current rules.
If a task was repeatedly not completed, communication failed or the outcome did not match the written scope, use the quality-concerns guide. Describe the service and evidence rather than attacking a person.
If the participant wants a future scope or timing adjustment, copy the facts into the change request template.
Facts still unknown or disputed: ___________________________________________________
Person who can clarify them: ______________________________________________________
Date clarification was requested: __________________________________________________
Use “unknown”, “not observed” or “disputed” where that is the honest status. Do not ask the participant or worker to sign a statement they cannot verify, and do not convert an estimate into an exact attendance time.
Once follow-up is complete, add the response without erasing the original entry. Record the name, role and date of the person providing the clarification so a later reader can distinguish the first observation from the resolved record.
Store the record with access limited to the participant and people who need it for service, billing or complaint purposes. Remove unnecessary details about other residents. The NDIA’s consent guidance explains that information authority can be limited and withdrawn.
The NDIA record-keeping guidance, service-agreement information and NDIS Code of Conduct used here were reviewed on 4 September 2026. Recheck current requirements when relying on the record.
