Thursday, 11 February 2016

Model SIR Format

Date: Mon, 1, 2016 at 11:58 AM
Subject: Model SIR Format
To: <>  

Dear sir ,

This is D.Jyothy Member CWC SPSR Nellore district sometimes we are giving order for SIR to NGOs but there is no specific format for SIR .Please give me model format to SIR.
Dear Madam,
We are thankful to you for your query and here below is.

(As per Section 33 of JJ Act- 2000)

R.C. NO: CWC/PRK19/1/2016.
Type of Intervention:                               SIR Conducted by:                Dept.:
  Particulars of the Child
Name of Child/Survivor
Place  of  interview

Police Station Details
Name of Station
JJ Act.
POCSO Sections
Cr. Pc/IPC Sections
CLPRA Sections
Child Marriage

a.   Interviewed: Parent / Guardian / Siblings / Neighbors / School Teacher / Friends / Other:
Personal Details of interviewed person
1st person (Family)
2nd person (Neighbor)


How was the relationship with survivor child

Standard of Living of the survivors family (details of property, other family members living in house)

b.    Details of Child/ Survivor’s Family:

Sl. No.
Other details

c.   Details of the child/ survivor:   
Full Name of Child

Age (please collect/attach copy of any age proof like
birth certificate/  school leaving certificate):

Educational Qualification :

Name of the school last attended:

Reason for leaving school:

Was the child working? If so where?

Detail Description of the child including any birth marks:

Date : when the child/ survivor went intervene :

How did the child/ survivor intervene? Please describe in details

Who was child/ survivor last seen with, what time, what clothes were they wearing:

Relationship of person (last accompanied) with the child/ survivor.

Date of last contact:

Has the child/ survivor been missing before: (Details)

Involvement of any family/community members in trafficking?

Does the child/ survivor have any history of addiction/s:

Medical conditions(including physical & history of disease /illness) of the child/victim:

Does the child/ survivor have any personal habits:
(twitch, cracking fingers or others)

 Whether the case complaint been filed:
If yes, where filed, complaint number, police station. If not the reason behind that?

d.      Summary of Social query :
v  Details of local environment / surrounding area / community keeping in mind the child best interest.

v  Relation with the Community

v  Economical condition of the Family

v  Family Relation with child

v  Views of other stake holders ( Specify: ________________________  )

v  Observations /Findings by the  Interviewer handling the case:

v  Suggestions by the Interviewer as per ‘Best interest of the Child’:

v  Specify whether the child/ survivor should be reintegrated to the family & why

Details of interviewer:
Name & Signature

Office Use
SIR Ordered on:
SIR Submitted on:

Total No. of days taken
to submit SIR
Received on:
Received by:
(Name & Signature)

Remarks if any: 

With best regards,

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