Anexa 3

Ancheta social
Evaluare iniial
din

Aprobat

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Primar

A. Doibani

Comisia de examinare a condiiilor locative i sociale: (Numele, Prenumele, Funcia membrilor comisiei)
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A cercetat condiiile de trai ale familiei
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Domiciliat pe adresa
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Tel.
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Am constatat urmtoarele:
COMPONENA FAMILIEI
Numele, prenumele

Data, luna,
anul naterii

Statutul social
al persoanei

IDNP

Legitimaia

Gradul de
rudenie

CONDIIILE DE TRAI
Statutul legal al spaiului locativ (de subliniat).: locuin: de stat, chirie. Tipul de locuin: cmin, cas la
sol, apartament la bloc. Altele (specificai) :
Numrul de odi ___________________________ Suprafaa locativ
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Suprafaa total
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Alt imobil:
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Pmnt agricol ___________________________ Pmnt pe lng cas
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Bunuri: televizor ____ frigider_____ main de splat_____ ( ani)

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Alte bunuri ( autovehicol, maini agricole) ____ (ani)
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Condiii .Acces: la reeaua de gaze naturale _____, energie termic _____, energie electric _____, ap
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Altele
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Starea igienic sanitar:
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Venitul lunar al familiei. Indicai sursa i suma:
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Patologii sociale ale familiei (abuz de alcool, de droguri, violen domestic, abuz fa de copii, neglijarea
obligaiilor printeti)
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Problemele cu care se confrunt familia. Din relatrile membrilor de familie
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Asistena de care a beneficiat familia:
Data

Tipul de asisten

Organizaia care a
acordat ajutorul

Motivul solicitrii

Suma,
Mrimea

Concluzii
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Recomandri
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Semnturile membrilor comisiei:
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