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Carer impact statement for the NDIS: free template

Free · Australia and the NDIS · By The Jay Way team

A carer impact statement explains the care you give your child and what it means for the rest of the family: work, sleep, siblings, getting out of the house. It helps whoever reads your child’s NDIS information understand what an ordinary week looks like.

Start with one real situation from the past few weeks. Say what happened, what you did and how often it happens. Plain words are fine. Include what your child enjoys and is good at, not only the hard parts.

The NDIS considers information from families and carers alongside professional reports. This is not an official NDIS form.

How to use it

Fill in whatever you can. Every box is optional. Build the sheet, then change anything you like before you copy or print it.

Nothing you type leaves this page. It isn’t saved or sent to us, so copy or print your sheet before you close the tab. Leave out full names, NDIS numbers and anything you wouldn’t want passed on. Our site analytics only count that the tool was used.

See a filled-in example

The child and details are made up. It’s here to show how much detail helps.

Carer impact statement (draft)

Your child’s initial or nickname (optional)
Sam (example)

What your child enjoys and is good at
Loves choosing a library book and looking at animal pictures.

A situation from a normal week
During our last three library visits, the busy entrance made it hard to get inside.

What you do to help
I stayed beside Sam, waited outside with them and helped communicate when they were ready to try again.

How it affects you and the family
We set aside extra time and sometimes left before choosing a book. I want to describe the support involved without losing sight of what Sam enjoys.

What has changed
The library moved its children’s session to a busier time last month.

Notes or reports that back this up
My notes from the three visits. Ask whether the existing communication report describes support outside home.

What you want to ask about
What information would help explain the support Sam needs to take part in community activities?

Written by me as the parent or carer. This is not a professional assessment or an NDIS funding recommendation.

Your notes

You can leave their name out.

Interests, strengths, things they want to do.

What happens, where, and how often.

Before, during and after. Add how long it takes if you know.

Work, sleep, siblings, your own health, time to yourself.

Since the last plan or meeting. A date helps.

A diary entry, your own dated note or a report title. Don’t paste whole reports.

The help you need or a question for your NDIS contact.

Sources and limits

Checked . The Jay Way wrote these prompts. They aren’t an official form or assessment.

Written by me as the parent or carer. This is not a professional assessment or an NDIS funding recommendation.