What's in this template?
Two blank forms in one Word document, for registered NDIS providers that use regulated restrictive practices: the implementing providers that Module 2A (Implementing Behaviour Support Plans) applies to. Part A is built from section 15 of the NDIS (Restrictive Practices and Behaviour Support) Rules 2018, the record keeping condition. Part B follows the monthly report in the NDIS Commission Portal, where a provider makes the reports section 14, the monthly reporting condition, requires.
The template includes:
- A cover and a "How to use these forms" page: what each form is for, who completes it, where completed forms are kept, and the reporting clocks
- Part A, Record of use of a regulated restrictive practice (one form per use): the participant and plan identifiers your service uses, the type and sub-type, whether it was routine, PRN or a once off emergency use, then the eight records section 15(2) requires, each in its own box. The people involved and any witnesses are two separate tables, each with contact details. It closes with whether the use was within the plan and its authorisation, the fields the portal asks for a PRN use, a debrief section for an unauthorised use, and who completed the record
- Part B, Monthly reporting worksheet (one per authorised restrictive practice per month, landscape): the report details, the six usage values for a routine restrictive practice with the variation and prescription fields, the table of PRN uses, and the due date, submission and correction fields
Editable placeholder fields
Only the cover carries placeholders. Every box on the forms is left blank, because it is filled in for each use and each month.
- Practice name{{practice_name}}, ABN{{abn}}, NDIS registration number{{ndis_registration_number}}
- Restrictive practices lead{{restrictive_practices_lead}}: the person who checks the records and owns the monthly reporting
- Next review date{{next_review_date}}: when the forms themselves are next checked against the Commission's guides
How these forms sit beside your restrictive practices policy
Your Restrictive Practices Policy is a policy that sets the rule: when a regulated restrictive practice may be used, what authorisation it needs, the safeguards, and who reports. These are the forms that record the result: what happened each time, and what goes into each monthly report. The policy names the restrictive practices lead and says every use is documented and reported, and these forms are where that happens.
| Restrictive Practices Policy | These forms | |
|---|---|---|
| What it is | The rule for using, authorising, reducing and reporting regulated restrictive practices | The record of each use (Part A) and the worksheet for each monthly report (Part B) |
| When it is used | Approved once, reviewed at least annually | Filled in at every use and every month |
| Where it is kept | Published to staff and uploaded to ClinicComply as evidence | Completed forms stay in your own participant record system; the blank set is uploaded as evidence |
An unauthorised use is also a reportable incident, so it is handled under your Incident Management Policy and Procedure as well. Part A records the use; the incident procedure covers the notification, the investigation and the follow-up.
Where completed forms are kept
A completed Part A or Part B is a record about a participant. Keep completed forms in your own participant record system, in that participant's record. Keep each Part A for 7 years from the day the record is made (section 15(3)), and each Part B with the Part A records it draws on. Completed forms are not uploaded to ClinicComply. ClinicComply holds records about your organisation and the events in it, not an ongoing record about one person's care. What you upload is the blank set with your organisation's details on the cover, as evidence that your service has a way to record and report each use.
What the Rules and the Commission require
A record of every use (section 15). Section 15(1) requires a registered provider to keep written information about its use of regulated restrictive practices. Section 15(2) lists eight things that must be kept, at a minimum:
- A description of the use, including the impact on the person with disability or another person, any injury to them, whether the use was a reportable incident, and why the regulated restrictive practice was used
- A description of the behaviour of the person with disability that led to the use
- The time, date and place at which the use started and ended
- The names and contact details of the persons involved in the use
- The names and contact details of any witnesses to the use
- The actions taken in response to the use
- What other less restrictive options were considered or used before the use
- The actions taken leading up to the use, including any strategies used to prevent the need for it
Section 15(3) says a record "must be kept for seven years from the day the record is made". Part A follows section 15(2) in full, including witnesses, contact details and whether the use was a reportable incident.
A monthly report (section 14). Section 14(1)(a) requires monthly reports to the NDIS Commissioner on the use of regulated restrictive practices, and section 14(1)(b) requires a report every 2 weeks while a State or Territory short term approval is in force. The Rules set no day of the month. The Commission's monthly reporting guidance says monthly reports are due within 5 business days after the end of each month, and must be submitted for every authorised regulated restrictive practice in a behaviour support plan, even in a month it was not used. Check the Commission's current guides for how to make the 2-weekly report.
Routine and PRN are reported differently. For a routine restrictive practice the portal asks for one usage value for the month: Used as per plan, Varied use, Not used, Eliminated, No service provided, or Service provision has ceased. A single varied day makes the month Varied use, which then asks whether the variation became an unauthorised restrictive practice, and, for a chemical restraint, the new frequency, dosage and prescriber details. For a PRN restrictive practice, each use is entered one at a time with its date, start and end time, the implementing staff member, and whether it was in accordance with the protocol in the behaviour support plan. For a plan lodged before 12 October 2026, monthly reports are still made in the Commission's existing portal, which asks for different fields.
Unauthorised use. The Commission's guidance says a use is an unauthorised restrictive practice if it happens "before it has been authorised, after its authorisation has expired, or otherwise than in accordance with the participant's Behaviour Support Plan". It is a reportable incident. The Incident Management and Reportable Incidents Rules require notice in writing within 5 business days after the provider became aware of it (section 21). Where the incident is also a death, serious injury, abuse or neglect, unlawful sexual or physical contact or assault, or sexual misconduct, the notice is due within 24 hours (section 20). The Commission's own wording, on its reportable incidents page, is that an incident that "has resulted in harm to a person with disability" must be reported within 24 hours.
For a PRN restrictive practice, the Commission says the unauthorised restrictive practice report satisfies section 14 for that use, so the use is not entered again in the monthly report. For a routine restrictive practice, a variation that became an unauthorised restrictive practice is still reported in the monthly report as Varied use, answering Yes to the question about an unauthorised restrictive practice, and is also reported as an unauthorised restrictive practice.
Supine, prone, pin-down, takedown techniques and basket holds must never be used. The Commission's glossary says that if one is used it must be reported as Unlawful Physical Contact or Abuse, and abuse and unlawful physical contact are notified within 24 hours (section 20).
A debrief after an unauthorised use. Module 2A (Quality Indicators Guidelines, section 53(4)) expects workers and management to debrief after an unauthorised restrictive practice has been used, to identify areas for improvement and inform further action, and to document the outcomes.
Corrections. Where a submitted report has an error, the Commission's monthly reporting guides say to maintain the correct information on your own records. Part B has a place for that correction.
How to customise this template
- Download the Word document and replace each Placeholder{{placeholder}} on the cover with your organisation's details. Leave the boxes on the forms blank.
- Decide who completes Part A after a use and who checks it, and say so in your Restrictive Practices Policy.
- Decide where completed forms are filed in your participant record system, and how you will keep each Part A for 7 years from the day it is made, with the Part B worksheets beside them.
- Check the Part B labels against the Commission's current monthly reporting guides. They are the portal's labels as at 10 November 2026, and the portal is still changing.
- Upload the blank set to ClinicComply as evidence that your service has a way to record and report each use.
- Use one Part A per use and one Part B per authorised restrictive practice per month, printed or saved as new copies in your own system.
Related templates and tools
- Restrictive Practices Policy: the policy that sets the rule these forms record against, including the restrictive practices lead named on the cover.
- Incident Management Policy and Procedure: an unauthorised use is a reportable incident, notified and managed under this procedure as well as recorded on Part A.
- Is it a reportable incident?: a free decision tool for the incident question in Part A.
- Restrictive practice: the five regulated restrictive practices and what each covers.
- NDIS restrictive practices compliance guide: the wider rules for implementing providers.
- NDIS provider compliance: how restrictive practice duties sit within the rest of a provider's obligations.
Frequently asked questions
Do we upload completed forms to ClinicComply?
No. A completed Part A or Part B holds details about a participant, so it stays in your own participant record system. Upload the blank set, with your organisation's details on the cover, to show that your service has a way to record and report each use.
What must a record of each use contain?
Section 15(2) of the NDIS (Restrictive Practices and Behaviour Support) Rules 2018 lists eight things: a description of the use (including its impact, any injury, whether it was a reportable incident, and why it was used), the behaviour that led to it, the time, date and place it started and ended, the names and contact details of the people involved and of any witnesses, the actions taken in response, the less restrictive options considered or used first, and the actions taken leading up to the use, including strategies to prevent the need for it. Part A has a box for each.
How long do we keep restrictive practice records?
Section 15(3) says a record must be kept for seven years from the day the record is made. That is the day the record is written, which is not always the day of the use, so Part A records both. Keep each Part B worksheet with the participant's records, beside the Part A records it draws on.
When is the monthly report due, and do we report a month with no use?
The Commission says monthly reports are due within 5 business days after the end of each month. A report is needed for every authorised regulated restrictive practice in a behaviour support plan, even in a month it was not used: choose Not used, or No service provided if you delivered no service that month.
How is a PRN restrictive practice reported differently from a routine one?
A routine restrictive practice takes one usage value for the whole month. A PRN restrictive practice is reported use by use, with the date, start and end time, the implementing staff member and whether the protocol in the behaviour support plan was followed. Used as per plan and Varied use are not available for a PRN restrictive practice. Part A captures the PRN details at the time, and Part B lists each use for the month.
Does an unauthorised use go in the monthly report?
It depends on whether the restrictive practice is PRN or routine. For a PRN restrictive practice, not as a separate entry: the Commission says the unauthorised restrictive practice report satisfies section 14 for that use, so leave it out of the PRN table in Part B. For a routine restrictive practice, a variation that became an unauthorised restrictive practice is still reported as Varied use, answering Yes to the question about an unauthorised restrictive practice, and is also reported as an unauthorised restrictive practice. Either way, record the use on Part A and notify it as a reportable incident.
What if we make a mistake in a submitted monthly report?
The Commission's guides say to maintain the correct information on your own records. Part B has a correction field for the correct information, who made the correction and when.
Does this replace our restrictive practices policy?
No. The Restrictive Practices Policy sets the rules for using, authorising, reducing and reporting regulated restrictive practices. These forms are where each use and each monthly report is recorded under those rules. A provider using regulated restrictive practices needs both.