RAPORT DE ANCHETĂ SOCIALĂ

Urmare a sesizării d-nei/d-lui ……Ionescu Liviu…………………..................................

înregistrată la Directia Generala de Asistenta Sociala si Protectia Copilului sector.3, Bucuresti,
cu numarul ....................142/….2020............................…, s-au deplasat asistentii sociali………
in data de …11.11.2020……, la adresa din strada …Marginei..., nr 102 bl -, sc -., et -, ap -.,
Sector..3 Bucuresti, in vederea efectuarii anchetei sociale, constatand urmatoarele:
● Familia locuieste la adresa mai sus mentionata cu/fara forme legale(in cazul in care
familia locuieste fara forme legale se mentioneaza domiciliul legal)___________DA,
VIZA DE FLOTANT____________________
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● DATE DE IDENTIFICARE (Se mentioneaza aceste informatii pentru fiecare persoana care
locuieste la domiciuliu):

Nr. Nume si Data si CNP-BI/CI/ Stare Nivel Ultimul Profesi Grad de

crt prenume locul CN civila de loc de e rudenie
nasterii seria si studii munca/
numarul scoala
25.03.1985 Casatorita 10 Scoala fara Mama
clase Generala
1 Zidaru nr 192,
Sorina Bucuresti

2 19.02.1983 Casatorit 8 clase Scoala fara Tata

Zidaru Generla
Eugen- Domnesti
Marian nr 2

3 21.04.2008
Zidaru
David-
Andrei

4 11.09.2010
Zidaru
Andreea-
Elena
● DATE CU PRIVIRE LA STAREA DE SANATATE (Se noteaza antecedentele medicale si
starea actuala de sanatate pentru toate persoanele de la domiciliu precum si actele medicale
doveditoare. Se va mentiona numele medicului de familie):
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● DATE CU PRIVIRE LA VENITURI (Se mentioneaza toate sursele de venit si cuantumul

acestora. Vor fi mentionate, daca au existat, masurile de asistenta sociala de care a beneficiat
familia, precum si perioada in care a beneficiat de aceste drepturi. Se va face , de asemenea,
referire la datoriile pe care le are familia in momentul efectuarii anchetei sociale):
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● DATE CU PRIVIRE LA LOCUINŢA:

Casa □ Bloc □
Proprietate personală□ Închiriere de la stat □ alte forme________
Număr de camere___________
Suprafaţa___________
Construită din_____________ Pardosită cu ________________ Acoperită cu __________
Iluminare: electrică □ Alte forme: _________________________
Incălzire: centrală□ alte forme__________________
Canalizare_______________
Apă curentă □ fântană □ cişmea publică□ cişmea proprie□ apă caldă□

*Starea de igienă:
1. a camerelor de locuit: nesatisfăcătoare□ satisfăcătoare□ bună □ foarte
bună□
Motivati
raspunsul______________________________________________________
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 2. a camerei de bucatarie: nesatisfăcătoare□ satisfăcătoare □ bună □ foarte
bună□
Motivati
raspunsul______________________________________________________
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2. a camerei de baie:
nesatisfăcătoare□ satisfăcătoare□ bună □ foarte bună□
Motivaţi
răspunsul______________________________________________________
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*Aparate electrice şi electrocasnice:

________Televizor,frigider______________________________________________________
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*Observaţii:
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● REŢEAUA RELAŢIILOR SOCIALE (Se va menţiona natura relaţiilor cu familia extinsă,

vecini, autorităţi, antecedente penale, consum de alcool/droguri, comportamente
deviante.):
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OBSERVAŢII:
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● CONCLUZII ŞI PLAN DE SERVICII:
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ŞEF SERVICIU, ÎNTOCMIT,