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Click ‘Get Form’ to open the inland regional center special incident report in the editor.
Begin by filling in the 'Involved Consumer' section, including their UCI# and gender. Ensure you also enter the date of birth accurately.
Indicate where the incident occurred by selecting from options such as 'Residence', 'Day Program', or 'Community'. If applicable, provide the address of the incident.
Document the date and time of the incident, ensuring that you specify whether it was AM or PM.
Complete the vendor information section, including name, address, and phone number. If known, include the vendor number and type.
Identify yourself as the individual reporting the incident by filling in your name and title. Include any witnesses and their relationship to the consumer.
Select any applicable special incidents from the provided list that pertain to this report. Be thorough in your selections.
Describe what happened before, during, and immediately after the incident in detail. This is crucial for clarity.
If applicable, describe any alleged perpetrator details and actions taken to protect the consumer moving forward.
Finally, ensure all required signatures are completed at the end of the form before submitting it through our platform.
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Here are the main types of incident reports: Security Incident: This involves bdocHubes of physical or information security. Injury and Lost Time Incident Report: This involves documenting instances where employees are injured on the job, leading to time away from work. Exposure Incident Report: Sentinel Event Report:
What is a special incident?
A Special Incident is an unusual adverse event in the life of an individual receiving Regional Center services. The main categories for reporting are: Injuries requiring treatment beyond first aid. medical needs, accidents, injuries, other (medication refusal or medication documentation error only)
What is a special incident report?
Inland Regional Center (IRC) is a springboard to greater independence for people with developmental disabilities in the Inland Empire. We are a non-profit agency that has provided support to people with intellectual disabilities, autism, cerebral palsy, and epilepsy since 1972. Inland Regional Center ADRC Aging and Disability Resource Connection of San Bernardino County partners inland-regional-ce Aging and Disability Resource Connection of San Bernardino County partners inland-regional-ce
When must a written special incident report be submitted to the regional center?
Three Incident Report Samples Type of incident (injury, near miss, property damage, or theft) Location (Address) Date/time of incident. Name. Name of supervisor. Description of the incident, including specific job site location, the sequence of events, and the results of the event. Whether or not proper PPE was being used.
inland regional center special incident report
Inland regional center special incident report pdfWhat services does Inland Regional Center provideInland Regional Center DirectoryInland Regional Center locationsInland Regional Center phone numberInland Regional Center sirInland regional Center VendorizationInland Regional Center portal
Serious injury/accident including: o Lacerations requiring sutures or staples o Puncture wounds requiring medical treatment beyond first aid o Fractures.
Transparency and Accountability in Californias Regional
by C Hite 2020 Reporting by Regional Centers, that RCs must report special incidents to DDS within two working days of learning of them either through receipt
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