STATEMENT OF LIVED EXPERIENCE TEMPLATE
The Statement of Lived Experience assists the National Disability Insurance Agency (NDIA)
and the Administrative Reviews Tribunal (ART) to have a better understanding of your day-to
day experiences. The NDIA and ART have to consider whether your impairments are
permanent, and your permanent impairments cause you to have substantially reduced
functional capacity (SRFC). You must have SRFC in at least one category (mobility,
communication, learning, social interaction, self-care, or self-management)
Some of the questions might seem very specific. In preparing these questions, the NDIA has
reviewed the evidence you have already provided, and the questions are targeted to address
areas the NDIA thinks need further clarification. You can also add any further information you
wish. You are not obligated to answer any questions however, the more information and detail
that is provided, the better understanding the NDIA and ART will have about your life and
circumstances.
1. How far can you walk without taking a break?
2. Do you require a walker?
(a) Do you use any other walking aids like a walking stick to mobilise?
(b) If yes, was this prescribed and by whom?
3. Do you own a car?
(a) Can you drive?
(b) How long can you drive? Please describe in kilometres.
(c) How often do you drive?
(d) If yes, when was the last time you drove?
(e) Do you have any restrictions on your drivers’ licence? If so, what are the restrictions?
(f) If you own a car, has your car been modified to accommodate your impairments?
4. Can you travel using public transport?
(a) If yes, how many times a week on average, do you travel on public transport?
(b) Do you require assistance when traveling on public transport?
(c) Please describe the type of assistance you require when travelling on public transport.
5. The property in which you currently live, have you made any modifications to
accommodate for your claimed impairments?
(a) If yes, are these modifications medically recommended, and by whom?
6. Do you live alone, or do you live with other people?
7. Do you have friends? How do you maintain relationships with your friends?
8. Do you go out for coffee/ lunch? If yes, how often?
9. Do you attend any community activities or club? If yes, where, and how often?
10. Do you have family? How do you maintain relationships with family?
11. Are you currently undertaking any employment or study?
(a) If yes, what type of employment do you do?
(b) How many hours/ week do you (would you) work?
(c) Do you work in an office environment? If yes, has there been any modifications made in your workplace?
12. Do you receive carer/ nursing assistance, whether paid or otherwise?
(a) If yes, please describe the services they provide you.
(b) Can your carer/ nurse provide a Carer’s statement?
13. Do you require assistance to complete your self-care needs, for example showering, toilet, eating, drinking, dressing yourself, etc.?
(a) If yes, please describe the assistance you require?
(b) Please identify who provides you with this assistance?
(c) Can the carer providing you self-care assistance provide a statement? If yes, please
provide their contact details?
14. Do you require prompting with your self-care such as personal hygiene needs?
(a) Please describe the promptings you require.
(b) How often are you required to be prompted?
(c) Please identify who prompts you with these needs.
15. Do you require assistance or prompts to take your medications?
(a) Describe the assistance or prompts you require.
(b) How often are you required to be prompted?
(c) Please identify who prompts you with these needs.
16. Do you require assistance to make decisions in relation to finances, budgeting and
managing bills?
(a) If yes, please describe the assistance you need.
(b) Who provides you with this assistance?
17. Do you have your own bank account?
(a) If yes, are you able to manage your account without assistance?
18. Do you speak with your friends and family?
(a) Do you communicate by telephone, and how frequently?
(b) Do you communicate via social media, and how frequently?
(c) How often do you interact with your friends and family in person?
19. How do you purchase groceries, clothing, and other daily necessities?
(a) Do you use meal and/or online delivery services for daily necessities?
(b) If your answer to the above is yes, please state the reasons on your reliance to online
services.
20. How do you do your domestic chores in your home? Such as washing, cleaning, cooking, gardening, etc.
(a) Do you do your chores independently?
(b) Do you receive help from someone with domestic chores, for example cleaning services? If yes, please provide description such as hours and frequency?
21. Do you have any reduction in your functional capacity for communication? If so, please provide details of the nature and extent of any reduction, and the cause of any reduction in functional capacity.
22. Do you have any reduction in your functional capacity for learning? If so, please provide details of the nature and extent of any reduction, and the cause of any reduction in functional capacity.
Additional Resources
NDIS TOOLKIT HERE