Templates & Forms · For professionals
Functional Capacity Assessment Template
A report structure built around the functional domains the NDIA considers.
A functional capacity assessment describes how a person impairment affects everyday activities. It records what a suitably qualified assessor observed and the reasoning behind any recommendations.
This template is built for an occupational therapist or other allied health assessor. It organises the report around the functional domains the NDIA considers, so the findings connect clearly to a person goals.
Download
Current as of July 2026
Free to download and use. Fill in the blanks, and remove any lines that do not apply to you.
What the report sets out
The report is completed by a suitably qualified assessor. The domains below mirror the areas the NDIA weighs when it looks at functional capacity; the recommendations connect each finding to the person goals.
- Participant details and the assessor name, profession, and registration number
- The reason for referral
- Relevant background and current supports
- The assessment methods and any standardised tools used
- Findings across communicating, socialising, learning, mobility, self-care, and managing daily life
- Any assistive technology in use, and how it helps
- Reasoned recommendations tied to the person goals
- The assessor declaration, signature, and date
How to use it
Occupational therapists
Anchor each finding to a functional domain and to the person goals. Where you recommend assistive technology, note how it helps, any prior equipment tried, and how it interacts with other supports, which mirrors what a general AT assessment covers.
Support coordinators using the report
A clear functional capacity assessment is strong evidence for a plan review. Pair it with the plan review report so the request and the reasoning arrive together.
Questions people ask
Who can complete a functional capacity assessment?
A suitably qualified assessor, such as an occupational therapist or other allied health professional. The report reflects their professional findings. This template organises the report around the functional domains, but it does not replace the clinical judgement and qualifications the assessment relies on.
What functional domains does the report cover?
Communicating, socialising, learning, mobility, self-care, and managing daily life. These mirror the areas the NDIA considers when it looks at functional capacity. Describing what was observed in each, and the impact on daily life, is what makes the report useful evidence.
How does the report support an assistive technology request?
By connecting a functional need to a recommendation. For assistive technology, the report notes how the item helps, any prior equipment tried, and how it interacts with other supports, which is the same ground a general AT assessment covers. That reasoning is what an assessor and planner weigh.
Official sources
Tools that pair with this
Related templates
NDIS Plan Review Report
Pull together goals, progress, and what is needed next before a plan reassessment.
NDIS Quote
Set out the cost of an item or support so it can be considered against a plan.
Support Coordination Report
Report on how supports were set up and how a participant is tracking against goals.
Get new templates as they land
The template library is refreshed each July against the current rules. Get a note when a new template is published or an existing one is updated.