GUARDIANSHIP PLAN
A guardian is appointed by the Queensland Civil and Administrative Tribunal (QCAT)
to make some or all personal decisions on behalf of an adult with impaired decision-making capacity.
You are asked to respect the privacy of the persons to whom this information may apply.
Checklist of Guardian’s responsibilities:

act as required by terms of Order;

apply General Principles;

act honestly and with reasonable diligence;

give the Tribunal a guardianship plan when requested;

keep records of guardianship decisions, with whom I consulted, or attempted to
consult, and the reasons for my decisions;

consult with other stakeholders, guardians and administrators;

if I am not available for decision-making, inform the relevant people/provide
emergency contact details;

advise Tribunal if changes to appropriateness or competence;

complete the Tribunal’s form “Guardian’s Report to the Tribunal” within two (2) weeks
of it being sent to me when my appointment comes up for review, and sent to Tribunal
with copies of completed Record of Decisions.
PRELIMINARY MATTERS
Surname of Adult:
Given Names:
Name of Guardian/s:
Tribunal Client No.
Date of Order:
/
/
Length of Order:
Matters for which Guardian/s is appointed:

all personal matters

OR
the following personal matters:

Accommodation

With whom _____________________________________ has contact and/or visits

Health care

Provision of services

Day-to-day issues, including, for example, diet and dress

Legal matters not relating to the adult’s financial or property matters

Whether ____________________ works and, if so, the kind and place of work and the
employer

What education or training ____________________________undertakes

Whether ___________________________applies for a licence or permit

Seeking help for, or making representations to ________________________________

A restrictive practice matter

Approving behaviour management plans
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
including the use of restrictive practices, if necessary
Directions Given to Guardian:
Adult’s current address:
Adult’s general practitioner:
Name:
Name:
Address:
Address:
Phone:
Phone:
Fax:
Fax:
Email:
Email:
Adult’s support agency/carers:
Name:
Name:
Address:
Address:
Phone:
Phone:
Fax:
Fax:
Email:
Email:
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1.
What difficulties do you see in doing the job as guardian and how will you solve these?
2.
I plan to change the adult’s:
Yes
Health Provider

Support Agency

Carer

Accommodation

Contact with family/friends

Lawyer

Employment/training

Day to day issues e.g., diet/dress 
Medical treatment

Other
(Please specify other planned changes)
No









3.
If yes to any of the above, please provide reasons and outline your proposed actions:
4.
People in adult’s life (family, friends, attorney/administrator) with whom I intend to
consult when making decisions:
Name:
Name:
Address:
Address:
Phone:
Phone:
Fax:
Fax:
Email:
Email:
Relationship to Adult:
Relationship to Adult:
Name:
Name:
Address:
Address:
Phone:
Phone:
Fax:
Fax:
Email:
Email:
Relationship to Adult:
Relationship to Adult:
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5.
6.
In making decisions, I do not plan to consult with the following people:
Name:
Name:
Address:
Address:
Phone:
Phone:
Fax:
Fax:
Email:
Email:
Relationship to Adult:
Reasons for not consulting this person:
Relationship to Adult:
Reasons for not consulting this person:
Name:
Name:
Address:
Address:
Phone:
Phone:
Fax:
Fax:
Email:
Email:
Relationship to Adult:
Reasons for not consulting this person:
Relationship to Adult:
Reasons for not consulting this person:
Individuals, health professionals and service providers, I plan to advise about my
appointment as guardian and my duties and responsibilities:
Name:
Name:
Organisation
Organisation
Address:
Address:
Phone:
Phone:
Fax:
Fax:
Email:
Email:
Name:
Name:
Organisation
Organisation
Address:
Address:
Phone:
Phone:
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Fax:
Fax:
Email:
Email:
7.
I plan to advocate for the adult so that he/she:
8.
How will you involve the adult in your decision-making or take into account previously
expressed wishes:
9.
How often do you intend to visit or contact the adult and/or make contact with his/her
service providers/other supports?
10.
I plan to maintain the adult’s existing supportive relationships by doing the following:
11.
If there is an appointed administrator or attorney for financial matters, how do you plan to
involve them in your decision-making?
12.
If I am temporarily not available for decision-making, I will inform the following people and
give them emergency contact details:
Name:
Name:
Address:
Address:
Phone:
Phone:
Fax:
Fax:
Email:
Email:
Relationship to Adult:
Relationship to Adult:
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Name:
Name:
Address:
Address:
Phone:
Phone:
Fax:
Fax:
Email:
Email:
Relationship to Adult:
Relationship to Adult:
13.
I plan the following to ensure the adult’s best interests are met and he/she is protected
from neglect, abuse or exploitation:
14.
I plan to record my guardianship decisions, with whom I consulted, or attempted to
consult, and the reasons for my decisions in the following manner:
15.
Since being appointed as guardian, I have already resolved the following:
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Only complete question 16 if you have been appointed as a guardian for a restrictive practice
16.
I will consult with the following parties in the development of a Positive Behaviour Support
Plan, and will only consent to the use of restrictive practices in compliance with that plan.
17.
I agree to complete the Tribunal’s form “Guardian’s Report to the Tribunal” within two (2)
weeks of it being sent to me when my appointment comes up for review.
Name of person completing this form:
Relationship to adult:
(If you are not a relative, please indicate how long
you have known the adult)
Your address:
Home:
Work:
Mobile:
Your telephone contact details:
(
(
)
)
Your email address:
Signed:
Date:
/
/
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Guardianship plan
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