Special Incident Reporting (SIR) Forms/Documents

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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.

Forms:

Instructions for Completing ACRC SIR Form

Special Incident Report

Shared Information Reporting

Death Report

Vendor Special Incident Report Requirements

SIR Resources:

Special Incident Reporting Requirements

ACRC Shared Information Report Instructions

Disability Rights California SIR

Steps to Reporting a SIR

Under Vendored Care

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.