Equipment Program

Transfer of equipment ownership to DCSI

Terms & Conditions agreement form

1 | DCSI – Paper Name Here

To be completed by client or non DCSI Equipment Program staff to transfer equipment to the Equipment Program
Enter details of equipment item(s) to be transferred below: / Date
  • Ownership of the equipment item(s) will transfer to the Department for Communities and Social Inclusion (DCSI) and the item(s) will be returned to DCSI when no longer required.
  • DCSI will be responsible for maintenance, repairs and replacement of the equipment item.
  • You will agree to regular reviews by a clinician to determine your ability to use the equipment item safely. If the equipment is a powered mobility aid, you will agree to have a medical clearance form completed by the GP or specialist prior to transfer of the equipment and then at regular intervals. If use of the equipment is deemed a safety risk at any time the equipment will be returned to DCSI.
  • Items that are accidentally damaged or stolen may be replaced by DCSI. The Motor Accident Commission provides users of motorised wheelchairs and scooters with third party bodily injury insurance cover at no cost. This insurance only covers legal liability for injury to other people as a result of an accident. It does not cover any injury to the user, damage to the wheelchair/scooter, or damage to any other person's vehicle or property. Wheelchair and scooter users are advised to seek cover for third party property damage from home & contents insurance providers.
  • The equipment will only be used for the purpose for which it was designed.
  • You will not sell or dispose of the equipment. If no longer required, it must be returned to DCSI.
  • DCSI equipment is on loan for your sole use and will not to be loaned to or used by anyone else. You will contact DES for collection of the item when no longer needed.
  • You will take reasonable care of the equipment and store the item in a secure weatherproof area.
  • You will not attempt to undertake any repairs or modifications to the equipment and you will contact DES to arrange repairs on 1300 130 302.

I agree to the above Terms and Conditions of the transfer of ownership to the Department for Communities and Social Inclusion for the equipment items listed below:

Only equipment items that are assessed as being in good working order or can be reasonably brought to an acceptable level will be accepted for transfer of ownership to DCSI. This transfer of ownership agreement is only valid subject to a successful maintenance check by Domiciliary Equipment Service.

Client/Guardian or transferring equipment program authorisation: Signature:

Client Name Client Number

1 | DCSI – Paper Name Here