Functional Capacity Assessment
Template current as of July 2026. Provided by Lion Med Supplies as general information, not advice. This is a structure for a suitably qualified assessor (for example an occupational therapist) to complete. It is not a substitute for professional judgement.
A functional capacity assessment describes how a person's impairment affects everyday activities. It sets out what the assessor observed and the reasoning behind any recommendations.
Assessment details
Participant name	 	
Date of birth	 	
NDIS number	 	
Assessor name and profession	 	
Registration / AHPRA number	 	
Date(s) of assessment	 	
Setting (home / clinic / telehealth)	 	
Reason for referral
Why the assessment was requested and what it needs to inform:
________________________________________________
Background
Relevant history, diagnoses reported by treating professionals, and supports currently in place:
________________________________________________
Assessment methods
Interviews, observations, and any standardised tools used:
________________________________________________
Functional capacity findings
Describe how the impairment affects each area of daily functioning. These domains mirror the areas the NDIA considers when it looks at functional capacity.
Domain	What was observed	Impact on daily life	
Communicating	 	 	
Socialising and relationships	 	 	
Learning	 	 	
Mobility and moving around	 	 	
Self-care	 	 	
Managing daily life	 	 	
Current supports and equipment
Support the person already receives, and any assistive technology in use:
________________________________________________
Recommendations
What the assessor recommends, and the reasoning that connects each recommendation to the person's goals and functional needs. For any assistive technology, note how it helps, any prior equipment tried, and how it interacts with other supports.
________________________________________________
Assessor declaration
I confirm that this assessment reflects my professional findings.
Assessor signature	 	Date	 	

Sources for the functional-capacity domains and the assistive technology assessment content: NDIS disability requirements and assistive technology assessment guidance, ndis.gov.au.