Special Incident Reporting (SIR)

TCRC has developed a Provider COVID-19 Checklist for providers to assist them in taking all of the necessary steps to report the incident, and to help protect the health & safety of individuals and staffs.

TCRC has also developed two supplemental forms to the SIR for COVID-19 reporting:

• TCRC Form for Reporting COVID-19 Exposure / Testing- Person Served
• TCRC Form for Reporting COVID-19 Exposure / Testing- Employee Staff

Special Incident Report (SIR) Form in Word

Special Incident Report (SIR) Online Form with E-Signature   (instructions)

TCRC has created a streamline procedure for special incident reporting (SIR).  The purpose of this process is to more effectively carry out the mandates of Title 17, California Code of Regualations, Sec 54327, that are meant to protect the safety and rights of people with developmental disabilities.

• SIR Letter to Vendors from the Executive Director of TCRC
• Sample Vendor Incident Report

Some of these forms and documents contain macros to simplify data entry. You may get a warning message regarding macros depending on your level of security. The macros have been tested and are safe to run.

Reporting SIRs

For all incident reports in SB/SLO Counties, fax to (805) 456-2197

For all incident reports in Ventura County, fax to (805) 456-0870

Reporting Regulations

Title 17: www.dds.ca.gov/Title17/T17SectionView.cfm?Section=54327.htm
Title 22: www.dss.cahwnet.gov/ord/PG240.htm   (Select Child Care, Residential, or Family Child Care from this page)

Risk Management Tools

Incident Response Checklist

Preventative Action Checklist

Additional Health and Safety Resources

Developmental Disabilities: Resources for Healthcare providers  www.ddhealthinfo.org/  

The Safety Net   http://www.ddssafety.net/  

American Heart Association www.americanheart.org  

American Diabetes Association www.diabetes.org  

American Medical Association Health Information
www.ama-assn.org/ama/pub/category/3158.html  

California Childcare Health Program
www.childcarehealth.org  

HealthFinder: US Department of Health and Human Services Health Information
www.healthfinder.gov  

Healthtouch Online
www.healthtouch.com  

National Cancer Institute
www.cancer.gov/cancer_information/  

National Institutes of Health – Health Information
www.health/nih.gov/