Załącznik

 WZÓR Karta czynności dozoru ................................................................................... w sprawie: Doz. ........................... Data, godzina rozpoczęcia i zakończenia, miejsce i rodzaj czynności dot. dozorowanego: ..................................................................... Uzyskane informacje oraz ustalenia Uwagi własne Realizacja obowiązku probacyjnego: ................................................................................. .. ( Ewentualne uwagi i polecenia kuratora zawodowego:  WZÓR D Doz. Sprawozdanie z objęcia/przebiegu/zakończenia dozoru I. Diagnoza osobopoznawcza i środowiskowa 1) Zatrudnienie .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... 2) Wykształcenie, kwalifikacje i umiejętności zawodowe .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ..............................................................................................................................  3) Stan majątkowy .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ............................................................................................................................. 4) Warunki mieszkaniowe .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .............................................................................................................................. 5) Stosunki i środowisko rodzinne .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .............................................................................................................................. 6) Tryb i styl życia .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ............................................................................................................................. 7) Inteligencja .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .....................................................................................................................................  8) Osobowość .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... 9) Postawa i sposób myślenia .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ..................................................................................................................................... .................................................................................................................................... 10) Stosunek do czynu i orzeczenia sądu ..................................................................................................................................... ..................................................................................................................................... .................................................................................................................................. .................................................................................................................................... ..................................................................................................................................... ................................................................................................................................... 11) Stan zdrowia ..................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ................................................................................................................................... 12) Uzależnienia .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ....................................................................................................................................  II. Dotychczasowa karalność, orzeczone kary i środki karne .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ..................................................................................................................................... III. Prowadzone postępowania karne w czasie dozoru .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ..................................................................................................................................... IV. Przebieg dotychczasowych dozorów i nadzorów .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ..................................................................................................................................... V. Zamierzenia readaptacyjne Plan/realizacja planu pracy z dozorowanym 1. Terminy i sposoby realizacji przez dozorowanego obowiązków ..................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ...................................................................................................................................... 2. Metody prowadzenia dozoru i kontroli zachowania dozorowanego ..................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ...................................................................................................................................... 3. Częstotliwość kontaktów z dozorowanym ..................................................................................................................................... .................................................................................................................................... ....................................................................................................................................  .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... 4. Możliwości realizacji dozoru i kontroli zachowania dozorowanego i przeszkody, które utrudniają tę realizację .................................................................................................................................... .................................................................................................................................... ..................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ...................................................................................................................................... 5. Inne planowane czynności w stosunku do dozorowanego .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ...................................................................................................................................... VI. Ocena postępów resocjalizacji i wykonania obowiązków .................................................................................................................................... .................................................................................................................................... ..................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ...................................................................................................................................... VII. Potrzeba ustanowienia, rozszerzenia, zmiany lub zwolnienia z orzeczonych obowiązków .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ...................................................................................................................................... .................................................................................................................................... ..................................................................................................................................... VIII. Wniosek o zakwalifikowanie dozorowanego do grupy ryzyka .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ...................................................................................................................................... ..................................................................................................................................... .....................................................................................................................................  IX. Źródła informacji o dozorowanym i jego środowisku .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... X. Ewentualne uwagi i zarządzenia kuratora zawodowego, kierownika zespołu lub sędziego ...................................................... ...................................................... ...................................................... ...................................................... ........................................................... ........................................................... ........................................................... ........................................................... ................................... ......................................... .......................................................... .......................................................... .......................................................... .......................................................... ...................................