Special Incident Reporting (SIR) Forms/Documents


Service providers 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, or dies, regardless of when or where the incident occurred. Please refer to Title 17, Section 54327 for reporting requirements.  Below are forms service providers can use to meet the mandate.

ACRC 552D Death Report

ACRC 552X Special Incident Report

Instructions for Completing ACRC SIR Form

ACRC Shared Information Report

ACRC Shared Information Report Instructions

Disability Rights California Requirements

Mandated Reporting Requirements Flow Chart -SIR

Review Special Incident Reporting Training Booklet to help ensure the safety of clients served by Alta California Regional Center and why we need to comply with Title 17.