Special Incident Reporting (SIR) Forms/Documents

All service providers and vendors have the responsibility to report incidents that impact a client’s health and/or safety while the client is receiving services or supports, or if the client is a victim of a crime, a mandated report has been filed for suspected neglect or abuse, or a client passes away, regardless of when or where the incident occurred. Please refer to Title 17, Section 54327 for reporting requirements. Below are forms and SIR resources to assist service providers with meeting the mandate.

Forms:

Special Incident Report (SIR) Form

Instructions for Completing ACRC SIR Form

Shared Information Form

Death Report

Vendor Special Incident Reporting Requirements May 2026

Incidents of Behavioral Restraints Seclusion and Involuntary Emergency Medication

SIR Resources:

DDS’ Vendor T17 Guidelines

ACRC Vendor T17 PPP

ACRC Shared Information Form Instructions

Mandated Reporting Requirements Flow Chart -SIR