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 and SIR resources to assist service providers with meeting the mandate.


Special Incident Report

Instructions for Completing ACRC SIR Form

Shared Information Reporting

Death Report

Vendor Special Incident Report List

Incidents of Behavioral Restraints Seclusion and Involuntary Emergency Medication

SIR Resources:

Special Incident Reporting Requirements

ACRC Shared Information Report Instructions

Under Vendored Care

Mandated Reporting Requirements Flow Chart -SIR

Vendor Supplement Information of Types of SIRs

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.